HIV/AIDS • CID 2004:39 (15 November) • 1507
H I V / A I D S M A J O R A R T I C L E
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
Katie B. Anderson,1Jodie L. Guest,1,3and David Rimland2,3
1Rollins School of Public Health at Emory University and
2School of Medicine, Emory University, and
3Atlanta Veterans Affairs Medical Center,
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 (
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
We compared survival among patients coinfected with human immunodeficiency virus (HIV)
).n p 970
HAART has been associated with a dramatic decrease in
clinical management of HIV-infected individuals, which
now must include the treatment of an array of chronic
diseases. The impact of coinfection with hepatitisCvirus
(HCV) is a focus of particular concern .
The prevalence of HCV coinfection in HIV-infected
individuals is high, ranging from 10% to 40%, and it
can be up to 80% in highly exposed cohorts [2–5]. This
high rate of coinfection is likely associated with shared
transmission routes, particularly injection drug use and
Received 7 April 2004; accepted 14 July 2004; electronically published 25
Reprints or correspondence: Dr. Jodie L. Guest, Atlanta VA Medical Center,
1670 Clairmont Rd., Mailstop 111-RIM, Decatur, GA 30033 (Jodie.Guest@med
Clinical Infectious Diseases2004;39:1507–13
This article is in the public domain, and no copyright is claimed.
the receipt of blood products or transfusions. The long
latency period prior to HCV disease may account for
the lack of considerable liver disease in HIV-infected
individuals before the introduction of HAART. With
improvements in treatmentandtherapy,HCVinfection
will continue to be a serious and highly prevalent dis-
ease in these longer-living individuals.
Numerous studies document the negative effects of
HIV coinfection on the course of HCV disease [6–10].
The effect of HCV coinfection on HIV disease pro-
gression has been extensively investigated, although
study findings differ widely in both the magnitude and
nature of the reported associations. Severalstudieshave
found significantly increased rates of progression to
death or of AIDS-defining events in HCV-coinfected
patients [4, 11–16], whereas others have found no such
effect [6–10, 17–20].
The present study is an extension of an earlier eval-
uation of the same cohort (the HIV Atlanta VA Cohort
by guest on February 2, 2016
HIV/AIDS • CID 2004:39 (15 November) • 1513
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