Systematic review and meta‐analysis of hepatitis C virus infection and HIV viral load: new insights into epidemiologic synergy

Abstract

IntroductionHepatitis C virus (HCV) and HIV infection frequently co-occur due to shared transmission routes. Co-infection is associated with higher HCV viral load (VL), but less is known about the effect of HCV infection on HIV VL and risk of onward transmission.MethodsWe undertook a systematic review comparing 1) HIV VL among ART-naïve, HCV co-infected individuals versus HIV mono-infected individuals and 2) HIV VL among treated versus untreated HCV co-infected individuals. We performed a random-effects meta-analysis and quantified heterogeneity using the I2 statistic. We followed Cochrane Collaboration guidelines in conducting our review and PRISMA guidelines in reporting results.Results and discussionWe screened 3925 articles and identified 17 relevant publications. A meta-analysis found no evidence of increased HIV VL associated with HCV co-infection or between HIV VL and HCV treatment with pegylated interferon-alpha-2a/b and ribavirin.ConclusionsThis finding is in contrast to the substantial increases in HIV VL observed with several other systemic infections. It presents opportunities to elucidate the biological pathways that underpin epidemiological synergy in HIV co-infections and may enable prediction of which co-infections are most important to epidemic control.

Impacts of hepatitis B and hepatitis C co-infection with tuberculosis, a prospective cohort study

“…At the end of tuberculosis treatment, 76% of hepatitis B infected HAART patients had less than II clinical stages, but 90% of hepatitis B free HAART patient had less than II clinical stages. The finding was in line with the 2016 systematic review report [ 45 ]. This is because of the effects of hepatitis B and hepatitis C viral infection on the immune system of the host that leads them to the poor response to treatments [ 46 , 47 ].…”

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

“…Our results on the effect of HCV on VL in ART-naïve individuals are not in agreement with a meta-analysis reporting no difference in VL by HCV co-infection status [5]. However, the primary outcome in this meta-analysis was based on the mean VL difference from a single VL measurement and most of the included studies did not account for HIV and HCV infection duration [5]. Interestingly, 4 of the 15 individual studies in the meta-analysis reported a significantly higher VL among HIV mono-infected individuals, which was also observed in our main analysis during the first year following HCVsc.…”

“…HIV infection often precedes HCV infection in MSM. This differs from the main risk groups in early studies of HIV/HCV co-infection, people who inject drugs (PWID) and haemophiliacs, in whom HCV was generally acquired before HIV infection [4,5].…”

“…One recent meta-analysis concluded that among ART-naïve HIV-positive individuals, those co-infected with HCV had similar HIV RNA viral loads (VL) to HIV mono-infected individuals [5], while other studies have reported that they do have faster CD4 T-cell count (CD4) decline [7,8]. Among individuals on cART, another meta-analysis reported that HCV co-infection leads to significantly lower CD4 counts shortly after initiating cART, but that HCV co-infection has no effect on achieving viral suppression [4].…”

“…Most studies in both of these meta-analyses included a heterogeneous risk group population (e.g. PWID and haemophiliacs), assessed the difference in VL using a single measurement in ART-naïve individuals, and included individuals with a prevalent HIV and/or HCV infection [4,5]. They were therefore unable to distinguish the sequence or duration of the two viral infections.…”