Hepatitis C virus co‐infection is a negative prognostic factor for clinical evolution in human immunodeficiency virus‐positive patients

Abstract

A longitudinal study of human immunodeficiency virus (HIV)-infected individuals followed-up in 13 centres was performed to assess the influence of hepatitis C virus (HCV) on the clinical and immunological evolution of HIV-infected patients. Eight-hundred and twelve HIV-infected patients with known HIV acquisition date, 89 co-infected with HCV, were included in the cohort. Clinical progression was defined as: 30% decrease of Karnofsky's index; and/or 20% body weight loss; and/or acquired immune deficiency syndrome (AIDS)-defining illness; and/or death (except by accident, suicide, or overdose). Immunological progression was defined as a decrease of initial CD4 count to below 200 mm(-3). If immunological progression was not statistically different between groups (P=0.25), clinical progression was significantly faster in HCV-HIV co-infected patients in univariate (P=0.02) and multivariable survival analysis (hazard ratio=1.63, P=0.03). This argues for active management of hepatitis C chronic infection among HCV-HIV co-infected patients.

Serological markers and risk factors for hepatitis B and C viruses in patients infected with human immunodeficiency virus

“…The low frequency found in our study could be explained by the low incidence of intravenous drug use and the infrequent transfusions in this population, which are very different to those reported in the studies cited from Latin America where intravenous drug use 13,18,25 and past history of transfusion 7 were the main risk factors identified for HCV infection in HIV patients.…”

“…Some studies have associated HCV coinfection with a faster HIV progression, although this conection is controversial 5,18,[21][22][23]30 . HCV infection also increases the toxicity to antiretroviral medications 9,18,26,27,32 .…”

High Levels of Chronic Immune Activation in the T-Cell Compartments of Patients Coinfected with Hepatitis C Virus and Human Immunodeficiency Virus Type 1 and on Highly Active Antiretroviral Therapy Are Reverted by Alpha Interferon and Ribavirin Treatment

“…The spontaneous clearance of chronic HCV infection is rare in monoinfection and probably even more so in HIV-1-coinfected subjects, although a few such cases have been described (8,10,30). Interestingly, some studies suggest that HCV/HIV-1 coinfection is associated with an increased rate of HIV-1 disease progression (14,22,24).…”

“…Some studies suggest that this is also true for HIV-1 disease (14,22,24), although this is not observed in all cohorts (28). The high levels of immune activation may contribute to high rates of viral disease progression by impairing the ability of the immune system to respond.…”

Differential regulation of cytotoxicity pathway discriminating between HIV, HCV mono and co-infection identified by transcriptome profiling of PBMCs

“…Compared to HCV mono-infected patients, co-infected individuals are also less likely to achieve viral clearance, and have higher HCV viral loads and more frequent HCV relapses after anti-HCV therapy [8][9][10][11]. Similarly, the possible role of HCV to accelerate HIV disease progression has also been reported by previous studies, which have shown the impaired CD4+ T cell count recovery during HAART, higher risk of AIDS, and liver disease-related deaths in co-infected individuals in comparison to HIV mono-infected ones [12][13][14][15][16][17][18][19]. Moreover, adverse drug reactions to HAART such as rash and hepatoxicity in HIV patients are exacerbated in coinfected patients, making the virological control of HIV harder to achieve [20][21][22][23][24].…”