HIV-HCV Coinfection Does Not Impair CD4 Cell Recovery after Starting Antiretroviral Therapy

Previous research has produced conflicting data concerning the effect of hepatitis C virus (HCV) coinfection on immunological response to antiretroviral therapy in people with HIV. Several studies have shown that coinfected patients experience slower or smaller CD4 cell gains after starting HAART compared with HCV monoinfected individuals, but others have reported no difference.

In the July 1, 2008 advance online edition of AIDS Research & Human Retroviruses, Marina Nunez, Vincent Soriano, and an international team of colleagues reported on a multicenter, retrospective, longitudinal study looking at CD4 cell restoration within 3 years after starting HAART in antiretroviral-naive HIV positive patients with or without HCV coinfection.

Of the 322 participants included in the analysis, 139 were HCV RNA positive and 183 were HIV monoinfected. Only individuals with sustained HIV virological suppression were analyzed. Factors predicting CD4 gains were assessed using multivariate linear regression.

Results

• The HIV-HCV coinfected patients were older, were more likely to have a history of injection drug use, and had less advanced HIV infection compared with the HIV monoinfected participants.

• Baseline CD4 count (OR -0.21; P = 0.01) and male sex (OR -0.19; P = 0.03) predicted smaller increases in absolute CD4 cell counts after 3 years of HAART.

• Higher baseline CD4 percentage (OR -0.38; P < 0.0001) and older age (OR -0.12; P = 0.03) predicted smaller gains in CD4 percentage after 3 years.
• A history of injection drug use was associated with smaller absolute CD4 cell count increases after 1 year of therapy (OR -0.20; P = 0.01).

• Use of regimens containing only nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) was associated with smaller gains in CD4 percentage.

• Conversely, use of zidovudine (AZT; Retrovir) as part of the NRTI backbone was associated with greater gains in CD4 percentage.

Based on these findings, the investigators concluded that, "HCV replication per se does not impair the CD4 restoration in HIV-infected patients successfully treated with antiretroviral therapy."

They added that, "Lower baseline CD4 counts are the strongest predictors of greater CD4 gains over a 3-year period, while a history of [injection drug use] negatively affects CD4 restoration only early after the initiation of HAART.

7/11/08

Reference
K Yacisin, I Maida, MJ Rios, and others. Hepatitis C virus coinfection does not affect CD4 restoration in HIV-infected patients after initiation of antiretroviral therapy. AIDS Research & Human Retroviruses. July 1, 2008 [Epub ahead of print]. ( Abstract )

FDA-approved Hepatitis C
Treatments

Pegasys + Copegus
PEG-Intron + Rebetol
Intron A + Rebetol
Roferon A + Ribavirin

-	Treatment Guidelines
-	Experimentals Treatments

FDA-approved HIV and
AIDS Treatments

Protease Inhibitors PIs
non Nucleoside Reverse
Transcriptase Inhibitors nNRTIs
Nucleoside / Nucleotide Reverse
Transcriptase Inhibitors NRTIs
Fixed-dose Combinations
Entry / Fusion Inhibitors EIs
Integrase Inhibitors

-	Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
-	Experimentals Treatments