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CD4 and CD4/CD8 ratio progression in HIV-HCV infected patients after achievement of SVR
A Saracino1, G Bruno1, L Scudeller2
1Clinic of Infectious Diseases, University of Bari, Italy.
Insights
Hepatitis C Virus (HCV) eradication significantly reduces liver-related mortality and fibrosis in HIV-HCV co-infected patients. However, it does not appear to impact long-term CD4 cell count or CD4/CD8 ratio trends during antiretroviral therapy.
Area of Science:
- Infectious Diseases
- Hepatology
- Immunology
Background:
- Long-term effects of Hepatitis C Virus (HCV) eradication on HIV disease progression remain unclear in co-infected patients.
- Understanding immune reconstitution post-HCV treatment is crucial for managing HIV-HCV co-infection.
Purpose of the Study:
- To evaluate the impact of sustained virological response (SVR) to anti-HCV therapy on HIV disease progression markers.
- To assess changes in CD4 cell counts and CD4/CD8 ratios following HCV eradication in HIV-HCV co-infected individuals.
Main Methods:
- Retrospective analysis of 116 HIV-HCV co-infected patients treated with Peg-IFN/RBV.
- Comparison of CD4, CD8 cell counts, CD4/CD8 ratio, FIB-4, and APRI trends between SVR and non-SVR groups over a median 8-year follow-up.
- Utilized multilevel mixed-effects models to analyze longitudinal data.
Main Results:
- SVR patients showed significant decreases in FIB-4 and APRI scores compared to non-SVR patients.
- No significant differences in absolute or percentage CD4 cell count slopes were observed between groups after adjusting for HIV duration.
- CD4/CD8 ratio trends showed similar progressive increases in both SVR and non-SVR groups; no deaths occurred in the SVR group versus six in the non-SVR group.
Conclusions:
- Achieving SVR in HIV-HCV co-infected patients significantly benefits liver outcomes, reducing mortality and fibrosis.
- HCV eradication does not appear to alter the long-term trajectory of CD4 cell count gain or CD4/CD8 ratio evolution in patients on antiretroviral therapy (ART).
Background:
In HIV-HCV co-infected patients, the long-term effects of HCV eradication on HIV disease progression are still unclear.
Objectives:
This study aims to determine if CD4 and CD4/CD8 ratio slopes improved after anti-HCV treatment in patients achieving a sustained virological response (SVR).
Study Design:
A total of 116 HIV-HCV co-infected patients, previously treated with Peg-IFN/RBV, were divided into two groups: SVR (55 patients who had achieved SVR), and non-SVR (61 patients). Retrospective data before and after anti-HCV therapy were obtained for all patients, with a median 8 year-follow-up. Multilevel mixed models were fitted to assess the trends over time of FIB-4 score, APRI score, CD4, CD8 cell count and CD4/CD8 ratio.
Results:
Median HIV-infection duration, HCV-RNA and GGT baseline levels were higher in non-SVR compared to the SVR group. A significantly decreased FIB-4 (p<0.001) and APRI trend (p<0.001) after SVR was observed in SVR patients compared to those non-SVR. After adjustment for HIV duration, there was no significant difference between the two groups for absolute CD4 (p=0.08) or percentage CD4 slope (p=0.6) over time. The CD4/CD8 ratio trend also demonstrated a similar progressive increase in both groups (p=0.2). During follow-up, six deaths were reported in the non-SVR group versus no death for the SVR group, while no difference in AIDS and non-AIDS events was observed.
Conclusions:
Achievement of SVR determines an important beneficial impact in terms of liver-related mortality and fibrosis regression, but does not seem to alter neither the slope of long term CD4 gain nor the CD4/CD8 ratio evolution in ART-treated HIV-HCV co-infected patients.
