Impact of chronic hepatitis C infection on outcomes of patients with an advanced stage of HIV-1 infection in an area of low prevalence of co-infection

Abstract

To ascertain whether hepatitis C (HCV) co-infection affects the progression of HIV infection, we initiated an eight-year prospective observational study at a university hospital in Taiwan where seroprevalences of HCV antibody and HIV antibody were low. Fifty-three (12.0%) consecutive non-haemophiliac HIV-1-infected patients with HCV co-infection and 387 (88.0%) patients without HCV and hepatitis B co-infection were enrolled between June 1994 and June 2002 and observed until December 2002. Outcomes evaluated included the risk for acute hepatitis, hepatic decompensation, HIV disease progression and mortality, and changes of CD4 þ count and plasma viral load (PVL) after initiation of highly active antiretroviral therapy (HAART) at the end of the study. The baseline CD4 þ count, PVL and proportion of patients with AIDS-defining opportunistic illnesses (OI) at study entry were similar between patients with HCV co-infection and those without co-infection, but HCV-co-infected patients were older (39 versus 35 years, P ¼ 0.01) and had a higher proportion of intravenous drug use (17.0% versus 0.8%, Po0.001). After a total observation duration of 1137 patient-years (PY) (median, 791 days; range, 3-3053 days), the incidence of acute hepatitis in HCV-co-infected patients was 13.89 per 100 PY (95% confidence interval [CI], 13.31-14.49) and that in patients without co-infection was 6.39 per 100 PY (95% CI, 6.24-6.55 per 100 PY), with an adjusted odds ratio (OR) of 2.769 (95% CI, 1.652-4.640). At the end of the study, CD4 þ count increased by 137 Â 10 6 and 157 Â 10 6 /L in patients with and without HCV co-infection, respectively, (P ¼ 0.47). The proportions of achieving undetectable PVL (o400 copies/mL) after HAART was similar (76.7% versus 74.9%, P ¼ 0.79). The adjusted OR for development of new AIDS-defining OI was 1.826 (95% CI, 0.738-4.522) in HCV-co-infected patients as compared with HCVuninfected patients. The adjusted hazards ratio for death of HCV-co-infected patients when compared with those without co-infection was 0.781 (95% CI, 0.426-1.432). Our findings suggested that HCV co-infection was associated with a significantly higher risk for acute hepatitis in HIV-infected patients receiving antiretroviral therapy, but it had no adverse impact on virological, immunological and clinical responses to HAART and survival when compared with patients without HCV and HBV co-infection.

Hepatitis C Virus Infection among Injection Drug Users with and without Human Immunodeficiency Virus Co-Infection

“…In this study, the prevalence of HCV/HIV co-infection was 52.1% (293/562), which is substantially higher than the prevalence reported by Hung et al in Taiwan during the period from 1994 to 2002 (9.6%) [38]. This discrepancy might be due to the difference in study populations: a prison-based population in the current study versus a hospital-based population in Hung's study.…”

Molecular Epidemiology of HIV Type 1 Subtypes in Taiwan: Outbreak of HIV Type 1 CRF07–BC Infection in Intravenous Drug Users

“…A likely explanation for such an observation is that coincident with the dramatic increase of CRF07_BC-infected cases in 2004 and 2005, the prevalence of HCV in HIV-1-infected IDUs was much higher after 2004 (54% vs. 95%, p ϭ 0.011) because the prevalence of HCV in HIV-1-infected individuals who were not IDUs in our cohort did not increase (7% vs. 10%, p ϭ 0.256). 26 Therefore, this HIV-1 outbreak among IDUs in Taiwan is likely accompanied by HCV coinfection, similar to the HIV-1 outbreak observed among IDUs in China. 14,15 The clustering pattern of our pilot analysis of the HCV genotype using NS5B sequences amplified from HIV/HCV coinfected individuals suggested that HCV transmission could have occurred on at least three separate occasions, giving rise to the circulation of genotypes 1a, 1b, and 6a (Fig.…”

Meta‐Analysis: Increased Mortality Associated with Hepatitis C in HIV‐Infected Persons Is Unrelated to HIV Disease Progression

“…Among the total of 1160 titles/abstracts screened, 52 papers were selected for in-depth review. Seven papers provided data from eras pre- and post- HAART introduction [11, 17-22]. For pre-HAART analysis, 10 studies were excluded for one or more of the following reasons: 1) AIDS and overall mortality were combined as a single endpoint [17, 23, 24], 2) lack of HCV-negative control [21, 25, 26] or 3) data were not able to be pooled [22, 27-29].…”

“…Some studies have reported a strong association between HCV/HIV coinfection and increased risk of HIV disease progression [8, 9], while other studies have not confirmed this result after the widespread use of HAART [10, 11]. This systematic review estimates the effect of HCV on both mortality and HIV progression in HCV/HIV coinfected patients in the era of HAART.…”