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Does hepatitis C virus co-infection accelerate clinical and immunological evolution of HIV-infected patients?
1Service des Maladies Infectieuses et Tropicales, Hôpital d'Enfants, CHU Dijon, France.
Insights
Hepatitis C virus (HCV) co-infection accelerates clinical progression in patients with human immunodeficiency virus (HIV). Early-stage HIV patients with HCV show faster disease advancement, suggesting active HCV management is crucial.
Area of Science:
- Infectious Diseases
- Immunology
- Hepatology
Background:
- Hepatitis C virus (HCV) co-infection is common in individuals with human immunodeficiency virus (HIV).
- The impact of HCV co-infection on the clinical and immunological trajectory of HIV infection requires further elucidation.
Purpose of the Study:
- To investigate the influence of HCV co-infection on the clinical and immunological progression of HIV-infected patients.
- To determine if HCV co-infection impacts disease advancement in HIV patients.
Main Methods:
- A longitudinal cohort study compared 119 HIV-infected patients with HCV co-infection to 119 matched HIV-infected patients without HCV.
- Clinical progression was defined by Karnofsky index decrease, body weight loss, AIDS-defining illness, or non-accidental death.
- Immunological progression was defined by a significant decrease in CD4 T-cell count.
Main Results:
- HCV co-infection was associated with significantly faster clinical progression in HIV patients (P < 0.005).
- Multivariate analysis confirmed HCV as a significant predictor of clinical progression (HR, 1.64; P < 0.05).
- HCV significantly predicted both clinical (HR, 10.9; P < 0.05) and immunological progression (HR, 2.31; P < 0.02) in patients with CD4 counts > 600 cells/µL.
Conclusions:
- Clinical progression is more rapid in HIV-HCV co-infected patients compared to HIV-monoinfected individuals.
- HCV infection is a significant prognostic factor for both clinical and immunological progression, particularly in early HIV stages.
- Active management of hepatitis C in co-infected patients, especially those asymptomatic with high CD4 counts, may prevent accelerated disease progression.
Objective:
To study the influence of hepatitis C virus (HCV) co-infection on clinical and immunological evolution of HIV-infected patients.
Design:
A longitudinal study of HIV-infected individuals with or without HCV infection, identified at the Infectious Diseases Department of Dijon University Hospital and enrolled in a historical cohort, was performed.
Methods:
One hundred and nineteen HIV-infected people co-infected with HCV and 119 matched individuals infected with HIV alone were included in the cohort (median participation time 3 years; range, 2 months to 11.5 years). Clinical progression was defined as one or more of the following: a 30% decrease in the Karnofsky index; a 20% loss of body weight; an AIDS-defining illness (for non-AIDS patients); death (except by accident, suicide or overdose). Immunological progression was defined as a 50% decrease in the initial CD4 T-cell count (for patients with an initial count > 100 x 10(6) cells/l). Effects of HCV co-infection were evaluated using Kaplan-Meier survival analysis and significance was tested using univariate (log-rank and Peto's tests) and multivariate methods (Cox's model).
Results:
In univariate analysis, immunological progression was not statistically different between the HCV-positive group and the HCV-negative group, whereas clinical progression was significantly faster in HCV-positive patients (P < 0.005, log-rank test). In a multivariate Cox model, clinical progression remained significantly associated with infection by HCV [hazard ratio (HR), 1.64; 95% confidence interval (CI), 1.06-2.55; P < 0.05]. Stratified multivariable analysis retained HCV as a significant prognostic factor of clinical progression (HR, 10.9; 95% CI, 1.09-109.3; P < 0.05) and immunological progression (HR, 2.31; 95% CI, 1.16-4.62; P < 0.02) for patients with an initial CD4 count above 600 x 10(6) cells/l.
Conclusions:
Clinical progression is more rapid in HIV-HCV co-infected patients than in HIV-seropositive patients are not infected by HCV. The prognostic value of HCV infection for both clinical and immunological progression is significant at early stages of HIV infection. These findings may argue for active management of hepatitis C infection in co-infected individuals, especially for asymptomatic patients whose CD4 count is above 600 x 10(6) cells/l, to predict and prevent accelerated progression of HCV and HIV diseases.