Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: Data from the HIV Atlanta VA Cohort Study

Rollins School of Public Health at Emory University, Emory University, Atlanta, Georgia, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 12/2004; 39(10):1507-13. DOI: 10.1086/425360
Source: PubMed

ABSTRACT We compared survival among patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) with that among patients infected solely with HIV.
Descriptive, bivariate, and survival analyses were conducted using data for all HIV-positive patients who were seen during the period of January 1997 through May 2001 in the HIV Atlanta VA Cohort Study (HAVACS) and who had been tested for HCV antibody since 1992 (n=970).
The prevalence of HCV coinfection was 31.6%, and coinfected patients were significantly more likely to be older, black, and injection drug users. In multivariate analysis, the duration of survival from the time of diagnosis of acquired immunodeficiency syndrome (AIDS) was significantly shortened for HIV-HCV-coinfected patients (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.09-3.10), as was time from HIV diagnosis to death (HR, 2.47; 95% CI, 1.26-4.82). Recovery of CD4+ cell count from the time of initiation of HAART did not differ significantly by coinfection status.
HCV coinfection is common in this HIV-infected population and negatively affects survival from the time of both HIV and AIDS diagnoses, although this is apparently not associated with a difference in CD4+ cell recovery while receiving HAART. These findings differ from those of a previous study that was conducted in this cohort in the pre-HAART era, which found no association between HIV-HCV coinfection and HIV disease progression.

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    ABSTRACT: Co-infection HIV/HCV or HBV is frequent because of the common ways of transmission of these various viruses. HIV-infected patients are living longer since the introduction of highly active antiretroviral therapy. However, co-infection with the hepatitis C virus (HCV) or hepatitis B virus leads to increased mor-bidity from liver disease and higher overall mortality. Noxious interactions between these viruses are currently well-known in particular acceleration by the HIV of the natural history of HCV or HBV infection. Recent progress was made in the diagnosis and management of the patients Co-infected by HIV/HCV or HBV. Although remarkable, this progress does not occult the need for continuing the preven-tive measures to reduce the acquisition of new infections and the development of new drugs more effective and better-tolerated to ensure a more important therapeutic success for all the Co-infected patients. La co-infection VIH/VHC ou VHB est fréquente du fait des voies communes de transmission de ces différents virus. Actuellement l'infection chronique du foie par le VHC ou le VHB est devenue la cause d'une importante morbidité et mortalité des patients porteurs du VIH du fait de l'augmentation de leur survie et la diminution de leur mortalité depuis l'introduction des TAR. Des interactions délétères entre ces virus sont actuellement bien connues notamment l'accélération par le VIH de l'histoire natu-relle de l'infection par le VHC ou VHB . Des progrès récents ont été réalisés dans la prise en charge diagnostique et thérapeutique des patients co-infectés par VIH/VHC ou VHB. Bien que remar-quables, ces progrès n'occultent pas la nécessité de poursuivre les mesures préventives visant à réduire l'acquisition de nouvel-les infections et le développement de nouvelles molécules plus efficaces et mieux tolérées pour assurer un succès thérapeutique plus important chez l'ensemble des patients co-infectés.
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    ABSTRACT: The long-term impact of pegylated-interferon plus ribavirin treatment outcome on CD4 T cell course in patients coinfected with human immunodeficiency virus and hepatitis C virus is largely unclear in the literature. The aim of this study was to investigate the impact of HCV-RNA clearance by standard anti-HCV therapy on long-term CD4 cells recovery in HIV/HCV patients on successful combined antiretroviral therapy. We retrospectively enrolled HIV/HCV-coinfected patients on HIV medications and treated for hepatitis C. CD4 + T cell counts were registered at baseline and after hepatitis C therapy. Multiple linear regression analysis was performed to identify independent predictors of CD4 + T cell change following the anti-HCV treatment outcome. Of the 116 patients enrolled, 54 (46.6%) reached a sustained virological response. During a follow-up of 24 months, the SVR group showed a mean annual increase in CD4 + T cell from baseline of 84 cells/ll at 1 year and of a further 38 cells/ll within the second year (P = 0.01, 0.001, resp.). An insignificant mean increase of 77 cells/ll occurred in the non-SVR group within month 24 (P = 0.06). Variables associated with greater CD4 gains were higher nadir, lower preinterferon CD4 counts, and lower body mass index (BMI).
    AIDS research and treatment 01/2015; 2015:687629. DOI:10.1155/2015/687629
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    ABSTRACT: Background Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. Methods We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010–11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. Findings 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53–2·37) and HCV co-infection (1·46, 1·25–1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89–1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02–1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80–1·10) or HCV co-infection (1·10, 0·97–1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16–1·62) and HCV co-infection (1·30, 1·17–1·45), but not HBV co-infection (0·93, 0·82–1·05), than among those with HIV only. Interpretation Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. Funding The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.
    The Lancet Infectious Diseases 10/2014; 14(11). DOI:10.1016/S1473-3099(14)70946-6 · 19.45 Impact Factor