Effect of hepatitis C virus on immunological and virological responses in HIV‐infected patients initiating highly active antiretroviral therapy: a meta‐analysis

Abstract

Co-infection of human immunodeficiency virus (HIV) with hepatitis C virus (HCV) is rather common. In the era of highly active antiretroviral therapy (HAART), viral hepatitis could result in adverse outcomes in HIV+ patients. The current meta-analysis aims to evaluate the impact of HCV on immunological and virological responses after HAART initiation in HIV/HCV co-infected individuals by synthesizing the existing scientific evidence. A comprehensive search of electronic databases was performed. Eligible studies were analysed using univariate and multivariate meta-analytic methods. Totally, 21 studies involving 22533 individuals were eligible. The estimated summary difference in CD4 cell counts increase between HIV and HIV/HCV co-infected subjects after 3-12 months on HAART was 34.86 cells/mm(3) [95% confidence interval (CI): 16.82-52.89]. The difference was more prominent in patients with baseline CD4 counts below 350 cells/mm(3) (38.97, 95% CI: 20.00-57.93) and attenuated 2 years later (13.43, 95% CI: 0.83-26.04). The analysis of ratio measures yielded similar findings. The virological control remained unaffected by the presence of HCV (adjusted Hazard Ratio for co-infected patients vs those with HIV alone: 0.99, 95% CI: 0.91-1.07). The bivariate meta-analytic method confirmed the results of the univariate approaches. This meta-analysis supports the adverse effect of HCV on immune recovery of HIV+ patients initiating HAART, especially of those with initially impaired immunologic status. Although this effect diminishes over time, early administration of HAART in the setting of co-infection seems to be justified.

Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status

“…Our study confirms several prior studies that found an association between HIV/HCV co-infection and a reduced immunologic, but not virologic, response to ART, [3][4][5][6][7][8][9] as well as studies demonstrating improved immunologic response among women compared with men. [20][21][22][23][24] Similar to the findings of a recent meta-analysis by Tsiara et al, 5 Int, p value for interaction across sex strata.…”

“…[20][21][22][23][24] Similar to the findings of a recent meta-analysis by Tsiara et al, 5 Int, p value for interaction across sex strata. Data are given as hazard ratios (95% confidence intervals) derived from Cox regression models.…”

“…1,2 HIV/ HCV co-infection may also reduce the response to antiretroviral therapy (ART), [3][4][5][6][7][8][9] and ultimately increase the risk of mortality among HIV-infected individuals. [10][11][12] HIV/ HCV-co-infected individuals are considered a priority population for HCV treatment due to more rapid liver disease progression in the setting of HIV infection.…”

Modelling CD4 T Cell Recovery in Hepatitis C and HIV Co-infected Children Receiving Antiretroviral Therapy

“…Similarly, a meta-analysis conducted by Tsiara et al 40 in 2013 of 21 studies involving 22,533 adult patients reported that even though HCV had a demonstrable adverse effect on immune reconstitution in the first 2 years of ART, this trend was not sustained in the long term. Our findings in children (Fig.…”

Directly acting antivirals for hepatitis C virus arrive in HIV/hepatitis C virus co-infected patients

“…A meta-analysis of patients initiating cART found that although HIV viral suppression was unaffected, patients with HIV/HCV experienced a smaller rise in CD4 þ cell count on ART compared with HIV mono-infected patients [30]. A recent cohort study of over 9000 individuals with HIV infection found that in the cART era, HCV co-infection not only increases the risk of liver mortality but also increased the risk of HIV and/or AIDS-related mortality.…”