Coinfection

IDWeek 2014: HIV/HCV Coinfected People Do Not Have Poorer CD4 Cell Recovery

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Among HIV positive people on suppressive antiretroviral therapy (ART), hepatitis C virus (HCV) coinfection was not associated with significantly lower CD4 T-cell or B-cell gains, according to study findings presented at IDWeek 2014 last week in Philadelphia.

A number of previous studies have found an association between HIV/HCV coinfection and slower or less extensive immune reconstitution after starting HIV treatment. However, much of this research was done earlier in the epidemic when ART was not as good and many people had extensive immune dysfunction before starting treatment.

Michael Abers from Baylor College of Medicine and colleagues looked at the association between HIV/HCV coinfection and recovery of both CD4 T-cells, which regulate immune response (known as cellular immunity), and B-cells, which produce antibodies (known as humoral immunity). They compared the effect of ART on CD4 and B-cell levels in people with HIV alone and those with both HIV and HCV.

This retrospective observational analysis included 160 people with HIV, mostly men, of whom about one-quarter were coinfected with HCV. Participants were on combination ART and achieved undetectable HIV viral load within 1 year of starting treatment. The researchers looked at CD4 and B-cell levels prior to ART initiation and after 9-15 months with persistently undetectable viral load.

Results

  • Absolute gains in CD4 and B-cell counts, as well as percentage changes, did not differ significantly between the HIV monoinfected and coinfected groups.
  • Looking at CD4 cells, people with HIV alone gained a median 199 cells/mm3, compared with 162 cells/mm3 for HIV/HCV coinfected people -- not a significant difference.
  • Turning to B-cells, gains were 84 cellsfor those with HIV alone and 91 cellsfor coinfected people, again not significant.
  • Percentage increases in CD4 cells and B-cells were strongly correlated for both HIV monoinfected and HIV/HCV coinfected people.

"In this cohort of patients with 9-15 months of suppressed viremia after ART initiation, HCV coinfection did not significantly influence the magnitude of reconstitution of CD4 or B-cell counts," the researchers concluded.

Given the lack of difference between the groups, and the correlation between CD4 and B-cell levels, they added that their data support guidelines that recommend against routine monitoring of B-cell counts.

10/22/14

Reference

MS Abers, Z Afzal, JE Weatherhead, et al. The Influence of Co-infection with HCV on CD4 and B-cell Reconstitution in Human Immunodeficiency Virus (HIV)-infected Patients. Abstract 1562.