Effect of incident hepatitis C infection on CD4+ cell count and HIV RNA trajectories based on a multinational HIV seroconversion cohort

Abstract

Background: Most studies on hepatitis C virus (HCV)/HIV co-infection do not account for the order and duration of these two infections. We aimed to assess the effect of incident HCV infection, and its timing relative to HIV seroconversion (HIVsc) in HIV-positive men who have sex with men (MSM) on their subsequent CD4 T-cell count (CD4) and HIV-RNA viral load (VL) trajectories. Methods:We included MSM with well-estimated dates of HIVsc from 17 cohorts within the CASCADE Collaboration. HCV co-infected MSM were matched to as many HIV monoinfected MSM as possible by HIV-infection duration and cART use. We used multilevel random-effects models stratified by cART use to assess differences in CD4 and VL trajectories by HCV co-infection status.Findings: We matched 214 (ART-naïve) and 147 (on cART) HCV co-infected MSM to 5,384 and 3,954 respectively matched controls. The timing of HCVsc relative to HIVsc had no demonstrable effect on VL or CD4 trajectories. In the first 2-3 years following HCVsc CD4 counts were lower among HCV co-infected MSM, but became comparable to HIV monoinfected MSM thereafter. In ART-naïve MSM, during the first two years after HCVsc, VL levels were lower or comparable to HIV mono-infected, tending to be higher thereafter. In MSM on cART, HCV had no significant effect on having a detectable VL.Interpretation: Irrespective of the duration of HIV infection when HCV is acquired, CD4 counts were temporarily lower following HCVsc, even when on cART. The clinical implications of our findings remain to be further elucidated.

Association of demographics, HCV co‐infection, HIV‐1 subtypes and genetic clustering with late HIV diagnosis: a retrospective analysis from the Japanese Drug Resistance HIV‐1 Surveillance Network

“…There are two possible reasons: HIV infection biologically increases the risk of HCV infection [ 38 ], and HIV is more easily transmitted by sexual contact than HCV [ 39 ]. Furthermore, HIV infection often precedes HCV infection in MSM [ 39 , 40 ]. Therefore, many HCV antibody‐positive participants at the time of HIV diagnosis likely acquired HCV following HIV infection and before HIV diagnosis, possibly related to a long period of high‐risk behaviour, that increases the risk of HCV infection.…”

“…This assumption partly explains the association between HCV antibody positivity and late HIV diagnosis. Another possible explanation is that HCV co‐infection may affect the CD4 count, which decreases after HCV seroconversion in PLWH compared with PLWH only [ 40 ]. However, the effect of HCV co‐infection on reduced CD4 count is transient [ 36 ], and HCV serostatus does not affect HIV disease progression [ 41 ].…”

Subtype‐specific differences in transmission cluster dynamics of HIV‐1 B and CRF01_AE in New South Wales, Australia

“…Studies of rates of CD4 decline have shown that various factors can influence the speed of decline. For example co-infection with HCV can increase the rate of decline of CD4 cells, [38] and CD4 counts may vary between different geographic areas with faster CD4 decline observed in Asia compared to Europe [39].…”

Prevalence of hepatitis B and C infections among HIV‐positive men who have sex with men: A systematic review and meta‐analysis

“…Fifty‐six studies fulfilled the inclusion criteria, as shown in Table 1 , comprising a total of 309203 MSM PLHIV. Switzerland contributed five studies, 18 , 20 , 37 , 38 , 39 United States had 11 studies, 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 Spain had four studies, 51 , 52 , 53 , 54 Netherlands had four studies, 55 , 56 , 57 , 58 three studies were from France, 17 , 59 , 60 six studies were from Taiwan, 22 , 61 , 62 , 63 , 64 , 65 eight studies were from United Kingdom, 19 , 21 , 23 , 25 , 66 , 67 , 68 , 69 two studies were from Europe, 70 , 71 two studies from Japan, 24 , 72 two studies from Australia. 73 , 74 One study each were from Belgium, 75 …”