Patients positive for both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) have a greater risk of developing liver disease, and a more rapid progression of liver fibrosis, cirrhosis, and end-stage liver disease. Coffee (Coffea spp., Rubiaceae) berry contains polyphenols and caffeine, which may have hepatoprotective properties. Studies show that consumption of ≥ 3 cups/day of coffee is associated with a decreased morbidity and mortality. Also, coffee consumption is associated with hepatoprotection in patients with liver disease. “The extent to which coffee consumption may be associated with a reduced risk of all-cause mortality in patients co-infected with HIV-HCV, a population where liver-associated complications and alcohol use are often present, remains unknown.” Hence, the purpose of this multicenter, prospective, cohort study was to evaluate the effect of coffee consumption on mortality risk in patients with HIV-HCV.
This study, known as the French ANRS CO13 HEPAVIH study, began in 2005 and recruited patients with HIV-HCV from 21 centers in France, to represent the French population. Included patients were ≥ 18 years and had an HIV-1 infection and chronic HCV co-infection. Patients who had already cleared HCV (had a sustained virological response to previous HCV treatment) and those who had spontaneously cleared HCV could be included. A standardized questionnaire was completed at study entry (month 0) and once per year for five years (every six months for patients with cirrhosis) to measure sociodemographic data and biological and clinical parameters related to HIV and HCV infections. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D). Alcohol consumption was assessed with the AUDIT-C questionnaire. Coffee intake and smoking status were also assessed. The primary outcome was deaths from all causes occurring between month 0 and month 72.
A total of 1,028 patients were included in the analysis. The median age was 49 years, and 70.2% were men. At study end, 53.3% had not started HCV treatment, 7% were on HCV treatment, 15.7% completed HCV treatment and were considered cured, and 24% completed treatment and were considered sustained responders. At baseline, 51.3% of patients had low coffee consumption and 26.6% had elevated coffee consumption (≥ 3 cups/day). The median follow-up duration was five years, equal to 4,700 person-years. Over the course of the study, 77 patients died; the mortality rate was 1.64/100 person-years. A total of 42.8% of the deaths were HCV-related, 11.7% were cancer-related (unrelated to HIV or hepatitis), 10.4% were AIDS-related, 3.9% were cardiovascular-related, 3.9% were overdose-related, 3.9% were suicide-related, 2.6% were respiratory-disease-related, and 14.3% were of unknown causes.
A lower mortality risk was associated with elevated coffee consumption at baseline (P = 0.032) and never smoking (P = 0.051). Compared with patients who were not treated or currently being treated for HCV, there was an 80% decrease in mortality risk in patients who cleared HCV (P = 0.011) and a 60% decrease in mortality risk in patients who completed treatment for HCV but not cured (P = 0.036). A higher mortality risk was also associated with not having a steady partner (P = 0.012), having severe fibrosis (P = 0.002), having HIV clinical stage C (P < 0.001), having CD4 cell count ≤ 200 cells/mm3 (P = 0.021), having a history of hepatocellular carcinoma and/or liver transplantation at enrollment (P < 0.001), and a history of indirect clinical signs of cirrhosis at enrollment (P < 0.001).
The authors conclude that elevated coffee consumption (≥ 3 cups/day) had an independent protective effect on all-cause mortality risk in patients with HIV-HCV. This is the first report of this association in this population. Among co-infected patients, HCV-related mortality was four-times higher than HIV-related mortality. When further analyzing HCV-related mortality using a model which took into account causes of death other than HCV, elevated coffee consumption remained significantly associated with a reduced risk of HCV-related mortality (P = 0.031). A limitation of this study was a lack of data about other caffeine or polyphenol sources and the type of coffee consumed (i.e., regular brewed versus espresso). Also, the study did not evaluate individual genetic differences in coffee metabolism and how this could have affected outcomes. Despite these limitations, the authors point out that the results are in-line with other reports showing a decrease in mortality with elevated coffee consumption. The authors conclude that the benefits of elevated coffee consumption “are more relevant in patients with HIV-HCV than in the general population.” Additional research is needed to determine whether coffee extracts and supplements would have the same effect as drinking a cup of coffee. The authors have no conflict of interest related to the primary outcome measure. The study was funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS) with the participation of Abbott France; Glaxo-Smith-Kline; Roche; Schering-Plough; and INSERM’s ‘Programme Cohortes TGIR.
Carrieri MP, Protopopescu C, Marcellin F, et al. Protective effect of coffee consumption on all-cause mortality of French HIV-HCV co-infected patients. J Hepatol. December 2017;67(6):1157-1167. doi: 10.1016/j.jhep.2018.01.032.