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The Impact of HCV Infection Duration on HIV Disease Progression and Response to cART amongst HIV Seroconverters in the UK.

Inshaw J, Leen C, Fisher M, Gilson R, Hawkins D, Collins S, Fox J, McLean K, Fidler S, Phillips A, Lattimore S, Babiker A, Porter K, UK HIV Seroconverters Coho - PLoS ONE (2015)

Bottom Line: HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2-4 and >4 years respectively), compared to mono-infected individuals.However, we found no evidence of an association for those with HCV>2 years (all p>0.89).Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45).

View Article: PubMed Central - PubMed

Affiliation: MRC Clinical Trials Unit at University College London, London, United Kingdom.

ABSTRACT

Introduction: The effect of HCV infection on HIV disease progression remains unclear; the effect of HCV infection duration on HIV disease progression is unknown.

Methods: We used data from a cohort of HIV seroconverters to investigate the effect of HCV infection duration on time from HIV seroconversion to CD4 <350 cells/mm3, AIDS or death, censoring at the earlier of cART initiation or last clinic visit, adjusting for confounders and splitting data into follow up periods from HIV seroconversion (<2, 2-4 and >4 years). We additionally compared CD4 cell decline following HCV infection to that of mono-infected individuals with similar HIV infection duration by fitting a random effects model. In a separate analysis, we used linear mixed models to we examine the effect of HCV infection and its duration on CD4 increase over 48 weeks following cART.

Results: Of 1655 individuals, 97 (5.9%) were HCV co-infected. HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2-4 and >4 years respectively), compared to mono-infected individuals. However, we found no evidence of an association for those with HCV>2 years (all p>0.89). Individuals experienced a somewhat greater decrease in CD4 count following HCV infection lasting 13 months, relative to individuals with HIV alone, (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45).

Conclusions: The impact of HCV co-infection on HIV disease progression appears to be restricted to the first year after HCV infection.

No MeSH data available.


Related in: MedlinePlus

Predicted declines in CD4 counts comparing HCV infected individuals to those with similar HIV duration without HCV infection.
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pone.0132772.g001: Predicted declines in CD4 counts comparing HCV infected individuals to those with similar HIV duration without HCV infection.

Mentions: Investigating CD4 cell decline following HCV infection, 63 HCV infected individuals and 1720 HCV uninfected individuals were included in the analysis. The model with the lowest AIC was one with a knot placed at 13 months after HCV infection. There was borderline evidence to suggest that in the first 13 months after HCV infection, individuals with HCV experienced greater CD4 decline per month than individuals without HCV infection (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). This is equivalent to a fall over 13 months of 43.29 cells/mm3 more for an individual with HCV infection compared to an individual with HIV mono-infection. After 13 months, there was evidence of CD4 recovery in individuals with HCV co-infection and their CD4 count increased per month relative to individuals without HCV (estimate = 3.99, 95% CI [1.48, 6.50] cells/mm3 per month, p = 0.002). Fig 1 shows predicted CD4 cell evolution over 2 years after HCV infection for a 20–30 year old MSM that HIV seroconverted after 1st January 2010.


The Impact of HCV Infection Duration on HIV Disease Progression and Response to cART amongst HIV Seroconverters in the UK.

Inshaw J, Leen C, Fisher M, Gilson R, Hawkins D, Collins S, Fox J, McLean K, Fidler S, Phillips A, Lattimore S, Babiker A, Porter K, UK HIV Seroconverters Coho - PLoS ONE (2015)

Predicted declines in CD4 counts comparing HCV infected individuals to those with similar HIV duration without HCV infection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4520682&req=5

pone.0132772.g001: Predicted declines in CD4 counts comparing HCV infected individuals to those with similar HIV duration without HCV infection.
Mentions: Investigating CD4 cell decline following HCV infection, 63 HCV infected individuals and 1720 HCV uninfected individuals were included in the analysis. The model with the lowest AIC was one with a knot placed at 13 months after HCV infection. There was borderline evidence to suggest that in the first 13 months after HCV infection, individuals with HCV experienced greater CD4 decline per month than individuals without HCV infection (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). This is equivalent to a fall over 13 months of 43.29 cells/mm3 more for an individual with HCV infection compared to an individual with HIV mono-infection. After 13 months, there was evidence of CD4 recovery in individuals with HCV co-infection and their CD4 count increased per month relative to individuals without HCV (estimate = 3.99, 95% CI [1.48, 6.50] cells/mm3 per month, p = 0.002). Fig 1 shows predicted CD4 cell evolution over 2 years after HCV infection for a 20–30 year old MSM that HIV seroconverted after 1st January 2010.

Bottom Line: HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2-4 and >4 years respectively), compared to mono-infected individuals.However, we found no evidence of an association for those with HCV>2 years (all p>0.89).Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45).

View Article: PubMed Central - PubMed

Affiliation: MRC Clinical Trials Unit at University College London, London, United Kingdom.

ABSTRACT

Introduction: The effect of HCV infection on HIV disease progression remains unclear; the effect of HCV infection duration on HIV disease progression is unknown.

Methods: We used data from a cohort of HIV seroconverters to investigate the effect of HCV infection duration on time from HIV seroconversion to CD4 <350 cells/mm3, AIDS or death, censoring at the earlier of cART initiation or last clinic visit, adjusting for confounders and splitting data into follow up periods from HIV seroconversion (<2, 2-4 and >4 years). We additionally compared CD4 cell decline following HCV infection to that of mono-infected individuals with similar HIV infection duration by fitting a random effects model. In a separate analysis, we used linear mixed models to we examine the effect of HCV infection and its duration on CD4 increase over 48 weeks following cART.

Results: Of 1655 individuals, 97 (5.9%) were HCV co-infected. HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2-4 and >4 years respectively), compared to mono-infected individuals. However, we found no evidence of an association for those with HCV>2 years (all p>0.89). Individuals experienced a somewhat greater decrease in CD4 count following HCV infection lasting 13 months, relative to individuals with HIV alone, (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45).

Conclusions: The impact of HCV co-infection on HIV disease progression appears to be restricted to the first year after HCV infection.

No MeSH data available.


Related in: MedlinePlus