Coinfected People May Achieve Smaller CD4 Cell Gains after Starting
HIV positive people coinfected with hepatitis C virus
(HCV) may experience impaired immune recovery, with
smaller increases in CD4 T-cells, after starting antiretroviral
therapy (ART), according to a study described in the
31, 2010 issue of AIDS. Investigators therefore
suggested that effective hepatitis C treatment might
help reduce HIV disease progression as well liver
estimated one-third of people with HIV
also have chronic hepatitis C.
Considerably research has shown that coinfected
individuals experience faster liver disease progression
and respond less well to interferon-based
hepatitis C treatment, but the effects of coinfection on
HIV disease progression are less well-defined and past studies
have produced conflicting data.
To shed more light on this issue, Martin Potter and fellow investigators
with the Canadian Co-infection Cohort Study examined changes
in CD4 T-cell counts among HIV positive people with chronic
hepatitis C infection and those who spontaneously cleared HCV.
About one-quarter of HCV monoinfected people clear the virus
without treatment, but spontaneous HCV clearance appears to
be less common among coinfected individuals.
The researchers analyzed data from 271 participants in a prospective
multi-center Canadian cohort of HIV positive adults with serologic
evidence of HCV infection. All were HCV antibody positive, but
while most also had detectable HCV RNA, or viral load, a small
proportion showed evidence of spontaneous clearance or control
of viral replication, with undetectable HCV RNA.
Baseline characteristics were similar for the 35 patients who
spontaneously cleared HCV and the 236 patients who did not,
except that those with chronic infection had more advanced liver
Investigators measured changes in CD4 cell counts over a median
follow-up duration of about 18 months.
with detectable HCV RNA -- indicating continued viral replication
-- had on average 7-fold slower CD4 cell recovery on ART
compared with HCV RNA negative participants (4 vs 26 cells/mm3,
respectively; P < 0.001).
recovery of CD4 cells did not improve over time.
were similar when looking only at the 95 participants (including
25 spontaneous clearers) who started ART for the first time.
only at participants who achieved undetectable HIV viral
load on ART, the reduction in CD4 cell recovery was less
evident and did not reach statistical significance.
was also a trend toward greater CD4 cell decline prior to
starting ART among people with detectable HCV RNA compared
with spontaneous clearers, but again the difference did
not reach statistical significance.
on these findings, the study authors concluded. "We found
that CD4 cell progression is negatively affected by the presence
of ongoing HCV replication in coinfected individuals initiating
ART which persisted throughout stable ART, suggesting active
HCV infection affects immune restoration even after years of
Therefore, they suggested, hepatitis C treatment might not only
prevent liver disease progression, but also reduce HIV disease
Lead investigator affiliation: Department of Medicine, Division
of Infectious Diseases, Royal Victoria Hospital, McGill University
Health Centre, Montréal, Québec, Canada.
M Potter, A Odueyungbo, H Yang, and others (Canadian Co-infection
Cohort Study Investigators). Impact of hepatitis C viral replication
on CD4+ T-lymphocyte progression in HIV-HCV coinfection before
and after antiretroviral therapy. AIDS 24(12): 1857-1865 (Abstract).
July 31, 2010.