Immune recovery is associated with persistent rise in hepatitis C virus RNA, infrequent liver test flares, and is not impaired by hepatitis C virus in co-infected subjects

AIDS. 2002 Sep 27;16(14):1915-23. doi: 10.1097/00002030-200209270-00008.

Abstract

Objectives: The impact of highly active antiretroviral therapy (HAART) on hepatitis C virus (HCV) is unknown. We analysed changes in HCV RNA and the frequency of hepatotoxicity in co-infected patient enrolling in AIDS Clinical Trials Group trials, and determined whether HCV impairs successful immune reconstitution in these populations.

Design/methods: In a prospective analysis of co-infected patients completing at least 16 weeks of HAART in four trials, and co-infected patients with available stored plasma from two other completed HAART trials, HCV RNA was measured at baseline and to week 48. A retrospective analysis of immune recovery in 40 HCV-RNA-positive and 129 HCV-RNA-negative patients from a single trial was performed.

Results: Prospective analysis: 60 patients completed at least 16 weeks of HAART. The mean HCV-RNA level increased 0.35 log IU/ml at week 16 and 0.43 log IU/ml at week 48. When stratified by baseline CD4 cell count, subjects' HCV-RNA levels increased 0.43 and 0.59 log IU/ml at weeks 16 and 48 for entry CD4 cell counts < 350 cells/mm, but only 0.26 and 0.1 log IU/ml at weeks 16 and 48 for entry CD4 cell counts > 350 cells/mm. Severe alanine aminotransferase elevations occurred in only 3.3%. Retrospective analysis: HCV co-infection had no effect on the overall mean CD4 cell increase at weeks 16 or 48 compared with uninfected controls.

Conclusion: In HCV-co-infected patients undergoing HAART, immune recovery is associated with a persistent increase in HCV RNA, especially with baseline CD4 cell counts < 350 cells/mm. HCV co-infection did not antagonize the CD4 cell response to HAART.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Cohort Studies
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / immunology*
  • HIV Infections / physiopathology
  • Hepatitis C / blood
  • Hepatitis C / complications
  • Hepatitis C / etiology
  • Hepatitis C / immunology*
  • Hepatitis C Antibodies / blood*
  • Humans
  • Male
  • Prospective Studies
  • RNA, Viral / blood
  • Retrospective Studies
  • Viremia / blood
  • Viremia / drug therapy

Substances

  • Anti-HIV Agents
  • Hepatitis C Antibodies
  • RNA, Viral