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Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status

Julia L Marcus1, Wendy A Leyden1, Chun R Chao2

  • 11 Kaiser Permanente Northern California , Oakland, California.

AIDS Patient Care and Stds
|June 11, 2015
PubMed

Insights

Hepatitis C virus (HCV) co-infection slows CD4 recovery and increases mortality in adults with HIV starting antiretroviral therapy (ART). Aggressive HCV treatment is recommended for all co-infected individuals, irrespective of sex.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Public Health

Background:

  • Hepatitis C virus (HCV) co-infection and biological sex are potential factors influencing antiretroviral therapy (ART) response in HIV-infected individuals.
  • Limited research exists on the combined impact of HCV status and sex on HIV-associated outcomes.
  • Understanding these interactions is crucial for optimizing HIV management.

Purpose of the Study:

  • To investigate the effects of HCV co-infection and biological sex on CD4 cell count changes, viral load suppression, and survival in HIV-infected adults initiating ART.
  • To determine if HIV/HCV co-infection influences ART effectiveness differently based on sex.
  • To provide evidence for tailored treatment strategies in co-infected populations.

Main Methods:

  • A cohort study of 12,865 HIV-infected adults initiating ART between 1996-2011 was conducted.
  • Piecewise linear regression analyzed CD4 count changes over 5 years, stratified by sex and HCV status.
  • Cox regression assessed hazards for viral suppression (<500 copies/mL), AIDS, and death, considering sex and HCV co-infection.

Main Results:

  • HIV/HCV co-infected individuals (both men and women) exhibited slower CD4 count increases in the first year of ART compared to HIV-mono-infected individuals.
  • After 5 years, women maintained higher CD4 counts than men, irrespective of HCV status.
  • HIV/HCV co-infection was associated with a 40% increased mortality risk but did not significantly impact AIDS incidence or viral suppression rates compared to HIV mono-infection.

Conclusions:

  • HIV/HCV co-infected men and women experience impaired CD4 recovery and elevated mortality risk following ART initiation.
  • Biological sex influences CD4 count trajectories, with women generally showing better recovery.
  • Aggressive treatment of HCV in co-infected adults, regardless of sex, is strongly recommended to improve long-term outcomes.

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