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Infection with GB virus C and reduced mortality among HIV-infected patients
H L Tillmann1, H Heiken, A Knapik-Botor
1Department of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Germany. tillmann@tx-amb.mh-hannover.de
Insights
GB virus C (GBV-C) coinfection is linked to better survival and slower disease progression in human immunodeficiency virus (HIV)-infected patients. This suggests GBV-C may influence HIV outcomes, potentially by inhibiting HIV replication.
Area of Science:
- Virology
- Immunology
- Infectious Diseases
Background:
- GB virus C (GBV-C), also known as hepatitis G virus, is a flavivirus not currently associated with any known disease.
- This study investigates the impact of GBV-C coinfection on the long-term prognosis of patients with human immunodeficiency virus (HIV) infection.
Purpose of the Study:
- To determine the relationship between GBV-C infection markers and the clinical progression of HIV disease.
- To explore correlations between GBV-C viral load and HIV disease parameters, including CD4+ cell count and HIV viral load.
Main Methods:
- Prospective follow-up of 197 HIV-positive patients, assessing GBV-C RNA and anti-E2 antibodies.
- Quantitative branched-chain DNA (bDNA) assay used to measure GBV-C viral load in plasma.
- Analysis of the association between GBV-C status and HIV disease progression, including survival and CD4+ cell counts.
Main Results:
- GBV-C RNA positivity was associated with significantly longer survival and slower progression to acquired immunodeficiency syndrome (AIDS) (P<0.001).
- Improved survival after AIDS diagnosis was observed in GBV-C positive patients.
- GBV-C viremia correlated inversely with HIV load (r=-0.33, P<0.001) and was associated with lower HIV loads.
Conclusions:
- Coinfection with GBV-C is associated with reduced mortality in HIV-infected individuals.
- GBV-C may inhibit HIV replication, contributing to a favorable HIV disease course.
- Alternatively, GBV-C infection might serve as a marker for other factors promoting a better HIV response.
Background:
The flavivirus GB virus C (GBV-C, also designated hepatitis G virus) was identified in a search for hepatitis viruses, but no disease is currently known to be associated with it. We investigated the relation between coinfection with GBV-C and the long-term outcome in patients infected with the human immunodeficiency virus (HIV).
Methods:
A total of 197 HIV-positive patients were followed prospectively beginning in 1993 or 1994. Of these patients, 33 (16.8 percent) tested positive for GBV-C RNA, 112 (56.9 percent) had detectable antibodies against the GBV-C envelope protein E2, and 52 (26.4 percent) had no marker of GBV-C infection and were considered unexposed. We assessed the relation between GBV-C infection and the progression of HIV disease. We also tested 169 GBV-C-positive plasma samples with a quantitative branched-chain DNA (bDNA) assay in order to investigate possible correlations between GBV-C viral load and both the CD4+ cell count and the HIV load.
Results:
Among the patients who tested positive for GBV-C RNA, survival was significantly longer, and there was a slower progression to the acquired immunodeficiency syndrome (AIDS) (P<0.001 for both comparisons). Survival after the development of AIDS was also better among the GBV-C-positive patients. The association of GBV-C viremia with reduced mortality remained significant in analyses stratified according to age and CD4+ cell count. In an analysis restricted to the years after highly active antiretroviral therapy became available, the presence of GBV-C RNA remained predictive of longer survival (P=0.02). The HIV load was lower in the GBV-C-positive patients than in the GBV-C-negative patients. The GBV-C load correlated inversely with the HIV load (r=-0.33, P<0.001) but did not correlate with the CD4+ cell count.
Conclusions:
Coinfection with GBV-C is associated with a reduced mortality rate in HIV-infected patients. GBV-C is not known to cause any disease, but it is possible that its presence leads to an inhibition of HIV replication. However, GBV-C infection could also be a marker for the presence of other factors that lead to a favorable HIV response.
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