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

van Santen, Daniela K.a; van der Helm, Jannie J.a,b; Touloumi, Giotac; Pantazis, Nikosc; Muga, Robertod; Gunsenheimer-Bartmeyer, Barbarae; Gill, M. Johnf; Sanders, Eduardg,h; Kelleher, Anthonyi; Zangerle, Robertj; Porter, Kholoudk; Prins, Mariaa,l,*; Geskus, Ronald B.a,h,m,n,* on behalf of the CASCADE Collaboration within EuroCoord

doi: 10.1097/QAD.0000000000002040
Epidemiology and Social

Background: Most studies on hepatitis C virus (HCV)/HIV-coinfection 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 MSM on their subsequent CD4+ T-cell count and HIV RNA viral load trajectories.

Methods: We included MSM with well estimated dates of HIVsc from 17 cohorts within the CASCADE Collaboration. HCV-coinfected MSM were matched to as many HIV monoinfected MSM as possible by HIV-infection duration and combination antiretroviral therapy (cART) use. We used multilevel random-effects models stratified by cART use to assess differences in CD4+ cell count and HIV RNA viral load trajectories by HCV-coinfection status.

Findings: We matched 214 (ART-naive) and 147 (on cART) HCV-coinfected MSM to 5384 and 3954, respectively, matched controls. The timing of HCV seroconversion (HCVsc) relative to HIVsc had no demonstrable effect on HIV RNA viral load or CD4+ cell count trajectories. In the first 2–3 years following HCVsc CD4+ cell counts were lower among HCV-coinfected MSM, but became comparable with HIV monoinfected MSM thereafter. In ART-naive MSM, during the first 2 years after HCVsc, HIV RNA viral load levels were lower or comparable with HIV monoinfected, tending to be higher thereafter. In MSM on cART, HCV had no significant effect on having a detectable HIV RNA viral load.

Interpretation: Irrespective of the duration of HIV infection when HCV is acquired, CD4+ cell counts were temporarily lower following HCVsc, even when on cART. The clinical implications of our findings remain to be further elucidated.

aDepartment of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam

bCentre for Environmental Safety and Security, National Institute of Public Health and the Environment, Bilthoven, The Netherlands

cDepartment of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece

dDepartment of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain

eRobert Koch Institute, Berlin, Germany

fDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada

gKEMRI-Wellcome Trust Research Programme, Kilifi, Kenya

hNuffield Department of Medicine, University of Oxford, Oxford, UK

iKirby Institute, UNSW Sydney, Sydney, New South Wales, Australia

jMedical University of Innsbruck, Innsbruck, Austria

kInstitute for Global Health, University College London, London, UK

lDepartment of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam

mDepartment of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center (AMC), Amsterdam, The Netherlands

nOxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.

Correspondence to Daniela K. van Santen, PhD, Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands. E-mail:,

Received 15 February, 2018

Accepted 9 August, 2018

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