8th Conference on Retroviruses and Opportunistic Infections Chicago, IL - February 4 - 8, 2001

Conf Retroviruses Opportunistic Infect 2001 Feb 4-8; 8:53 (abstract no. 34)

M. Sulkowski, R. Moore, S. Mehta, and D. Thomas
Johns Hopkins Univ. Sch. of Med., Baltimore, MD.

BACKGROUND: Chronic HCV infection acts as an OI in HIV-infected persons, since both its incidence and the severity of HCV-related liver disease are increased. However, the reverse impact, namely, the effect of chronic HCV infection on the natural history of HIV disease, is less certain. The objective of this study was to determine the effect of HCV coinfection on HIV disease progression and survival in a large, well-characterized patient cohort, controlling for age, HIV viral load, baseline CD4 count and antiretroviral therapy.

METHODS: HIV disease progression and survival were analyzed in a prospective, heterogeneous cohort of patients receiving medical care from January 1996 through June 2000 in the Johns Hopkins HIV Clinic. All patients underwent comprehensive baseline evaluation, including HCV EIA testing. Longitudinal data were collected, including labs, medication use, clinical outcomes, and death. Survival, progression to AIDS-defining illness (first OI) and to CD4 <200/mm³ were assessed, using Cox regression analysis.

RESULTS: 1742 HIV+ pts (45.1% HCV+) were followed. HCV+ pts were older, more likely to be black (85% HCV+ >65% HCV-) and use injection drugs (85% HCV+ >14% HCV-) but no differences were observed in baseline CD4 and HIV load. Compared to those without HCV infection, no difference was detected in HCV coinfected persons in progression of HIV infection, as measured by the occurrence of the 1st OI, CD4 cell decline, or death. Interestingly, initially an increased risk of progression to CD4 <200 and death [RH 1.74 (1.03-2.95)] was noticed in HCV+ pts with baseline CD4 count between 50 and 200/mm³. However, when HAART use and lack of HIV suppression to <400 c/mL were considered in multivariate analysis, HCV infection was no longer significantly associated with CD4 decline or survival [RH 1.18 (0.57-2.49)] whereas HAART use [0.30 (0.18-0.50)] and lack of HIV suppression [6.79 (2.10-21.9)] remained significant.

CONCLUSIONS: In this cohort, HCV infection does not substantially adversely affect HIV disease progression or survival after controlling for the use and effectiveness of HAART. Further research is necessary to identify the factors that determine the use and effectiveness of HAART in HCV coinfected patients, which may include adherence and HAART-related hepatoxicity.

2001-02-04
34

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