Impact of co-infection by hepatitis C virus on immunological and virological response to antiretroviral therapy in HIV-positive patients

Abstract

We assessed the effect of co-infection by hepatitis C virus (HCV) on immunological and virological response at 48 weeks from initiation of antiretroviral therapy (ART).We included patients from the Cohort of Spanish HIV Research Network (CoRIS) starting ART between January 2004 and November 2014, had at least 1 CD4 T-cell count and viral load measurements both in the previous 6 months and at 48 (±12) weeks from ART initiation, and HCV serology before ART initiation. We used linear regression for mean differences in CD4 T-cell count increase from ART initiation and logistic regression to estimate odds ratios for virological response.Of 12,239 patients by November 30, 2015, 5070 met inclusion criteria: 4382 (86.4%) HIV mono-infected and 688 (13.6%) HIV/HCV co-infected. Co-infected patients were more likely to have acquired HIV through injecting drugs use (57.4% vs. 1.1%), to be women, older, and Spanish, have a lower educational level, and having started ART with lower CD4 counts and acquired immunodeficiency syndrome. CD4 T-cell count increase at 48 weeks was 229.7 cell/μL in HIV-monoinfected and 161.9 cell/μL in HIV/HCV-coinfected patients. The percentages of patients achieving a virological response at 48 weeks were 87.0% and 78.3% in mono and coinfected patients, respectively. Multivariable analyses showed that at 48 weeks, coinfected patients increased 44.5 (95% confidence interval [CI]: 24.8–64.3) cells/μL less than monoinfected and had lower probability of virological response (odds ratio: 0.62; 95% CI: 0.44–0.88).HIV/HCV-coinfected patients have lower immunological and virological responses at 48 weeks from ART initiation than monoinfected patients.

Human immunodeficiency virus and hepatotropic viruses co-morbidities as the inducers of liver injury progression

“…As estimated, up to 25% of HIV- infected population in the United States are also co-infected with HCV[8]. Co-infection with HCV and HIV has been associated with a faster progression of hepatitis and a higher liver-related mortality even in the era of antiretroviral therapy (ART)[9,10]. The exact role of HCV-infection in the natural history of HIV-infection is not clear.…”

“…As reported, while HCV infection is not associated with an increase in AIDS-related events or deaths, co-infected individuals may have lower CD4 + T cell counts as compared to HIV-mono-infected patients[11,12]. In contrast, HIV co-infection produces numerous adverse effects by increasing replication of HCV[13], slowing down the HCV clearance, enhancing fibrogenesis[14] and decreasing the response to direct acting antiviral (DAA) treatment[10], ultimately increasing liver dysfunction and incidence of death. Eyster et al[15] compared the levels of HCV RNA before and after HIV-seroconversion in HCV-infected patients and reported that HCV RNA levels were enhanced 8-fold in patients co-infected with HIV compared to HCV mono-infected.…”

Hepatitis B and C virus infection among HIV patients within the public and private healthcare systems in Chile: A cross-sectional serosurvey

“…In addition, HCV treatment in PLWH is less effective [23,39]. The role of HCV as a co-factor in HIV disease progression remains controversial, but some studies have found lower absolute CD4+ cell counts and reduced immunological and virological responses after ART initiation [32,40,41].…”

Compartmentalization of Resistance-Associated Substitutions in HIV/HCV-Infected Patients: Possible Correlation with Infecting HCV Genotype

“…With the extended life expectancy offered by combined antiretroviral therapy, this patient subpopulation is at increased risk of long-term complications from HCV-associated chronic liver disease, including cirrhosis and hepatocellular carcinoma. The development of direct-acting antiviral agents (DAAs) has dramatically improved the treatment options for HCV, and a sustained virological response (SVR) in HIV/HCV coinfected patients is achieved at rates similar to those of HCV monoinfected patients [ 3 , 4 , 5 ]. However, outside of clinical trials, the population of HIV/HCV coinfected patients may have risk factors that, by themselves or in combination, may lead to lower SVR [ 6 ].…”