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Hepatitis C virus/HIV coinfection and responses to initial antiretroviral treatment

Hua, Leia; Andersen, Janet W.a; Daar, Eric S.b; Glesby, Marshall J.c; Hollabaugh, Kimberlya; Tierney, Camlina

doi: 10.1097/01.aids.0000432470.46379.dd
Clinical Science

Objective: To explore the relationship between hepatitis C virus (HCV)/HIV coinfection and responses to initial antiretroviral treatment (ART).

Methods: Four AIDS Clinical Trials Group HIV treatment studies’ data were combined to compare initial ART responses between HCV/HIV-coinfected and HIV-monoinfected patients as evaluated by virologic failure, CD4+ cell measures, occurrence of AIDS/death and grade 3/4 safety events, using Kaplan–Meier estimates and proportional hazard, regression and mixed effects models, adjusting for baseline covariates.

Results: Of the 3041 included participants, 81% were men, 19% had prior history of AIDS, the median (25th, 75th percentile) baseline HIV RNA was 4.72 (4.38–5.18) log10 copies/ml, and the median (25th, 75th percentile) baseline CD4+ cell count was 216.0 (76.5–327.0) cells/μl. The 279 HCV/HIV-coinfected individuals were older (44 vs. 37 years), more likely to be black non-Hispanic (47 vs. 36%), and previous/current intravenous drug user (52 vs. 5%) than the 2762 HIV-monoinfected patients (all P values <0.001). HCV/HIV coinfection was associated with earlier virologic failure, hazard ratio (95% confidence interval): 1.43 (1.07–1.91); smaller mean CD4+ cell increase and CD4+% increase [−33.8 (−52.2 to −15.4) cells/μl and −1.16% (−1.43 to −0.89%), respectively] over a median of 132 weeks of follow-up; earlier occurrence of grade 3/4 safety event, hazard ratio 1.51 (1.26–1.81); and increased AIDS/mortality, hazard ratio 2.10 (1.31–3.37). Treatment effects comparing antiretroviral regimens were not significantly different by HCV/HIV coinfection status.

Conclusion: HCV/HIV coinfection is associated with attenuated response to ART. Results support earlier initiation of HIV therapy and increased monitoring of those initiating ART with HCV/HIV coinfection.

aHarvard School of Public Health, Boston, Massachusetts

bLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California

cWeill Cornell Medical College, New York, New York, USA.

Correspondence to Lei Hua, PhD, Harvard School of Public Health, 651 Huntington Avenue, Boston, MA 02115, USA. Tel: +1 617 432 2526; fax: +1 617 432 3163; e-mail: lhua@sdac.harvard.edu

Received 27 March, 2013

Revised 15 June, 2013

Accepted 24 June, 2013

The present work has been presented at CROI 2012, Poster #779.

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© 2013 Lippincott Williams & Wilkins, Inc.