 |
|
Coinfection With Hepatitis Viruses and Outcome of Initial Antiretroviral Regimens in Previously Naive HIV-Infected Subjects
Andrea De Luca, MD;
Roberto Bugarini, BStat;
Alessandro Cozzi Lepri, PhD;
Massimo Puoti, MD;
Enrico Girardi, MD;
Andrea Antinori, MD;
Antonio Poggio, MD;
Gabriella Pagano, MD;
Giulia Tositti, MD;
Gianpiero Cadeo, MD;
Antonio Macor, MD;
Mario Toti, MD;
Antonella d'Arminio Monforte, MD;
for the Italian Cohort Naive Antiretrovirals Study Group
Arch Intern Med. 2002;162:2125-2132.
Background The effect of chronic coinfection with hepatitis viruses on the response to therapy against human immunodeficiency virus 1 (HIV-1) remains debated.
Methods In a prospective cohort study, the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) serostatus on the outcome of potent HIV-1 therapy was analyzed in HIV-1–infected patients previously naive to antiretroviral therapy. Changes from baseline CD4+ cell counts and HIV RNA levels over time were analyzed by linear regression models. Time to clinical progression and time to reach virologic and immunologic response were analyzed by multivariate Cox proportional hazards regression models.
Results We studied 1320 patients, among whom 600 were HCV antibody–positive and 90 were HBV surface antigen–positive. During a median follow-up of 37 months (range, 1-48 months), clinical progression was observed in 99 patients (56 new acquired immunodeficiency syndrome–defining events and 43 deaths). In multivariate models, HCV-positive HBV-negative patients showed a shorter time to clinical progression (hazard ratio, 1.55; 95% confidence interval, 1.00-2.41). Patients who were HCV-positive also showed mean CD4+ recoveries over time that were at least 30 cells/µL fewer than those of seronegative patients. Hepatitis virus serostatus did not affect the virologic response to HIV-1 therapy.
Conclusions Clinical progression of HIV-1 disease after starting potent antiretroviral therapy is accelerated by concomitant infection with HCV. Compared with patients without coinfection, coinfected patients showed impaired CD4+ cell recovery, despite similar virologic response to HIV-1 therapy. These findings may have important implications for the treatment of HCV and for the timing of initiation of HIV-1 therapy in coinfected individuals.
From the Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart (Dr De Luca), Centro Operativo AIDS, Italian Institute of Health (Dr Bugarini), National Institute of Infectious Diseases "L Spallanzani" (Drs Girardi and Antinori), Rome; Institute of Infectious and Tropical Diseases, University of Brescia (Dr Puoti), and Department of Infectious Diseases, "Spedali Civili" (Dr Cadeo), Brescia; Departments of Infectious Diseases "Ospedale Civile" Pallanza, Verbania (Dr Poggio), Hospital "S Martino," Genova (Dr Pagano), Hospital of Vicenza, Vicenza (Dr Tositti), "Amedeo di Savoia" Hospital, Torino (Dr Macor), Hospital of Grosseto, Grosseto (Dr Toti); and Institute of Infectious and Tropical Diseases, University of Milano, Milano (Dr d'Armino Monforte), Italy; and Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, England (Dr Cozzi Lepri).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Treatment of Hepatitis C in HIV-Coinfected Patients
Hughes and Shafran
The Annals of Pharmacotherapy 2006;40:479-489.
ABSTRACT
| FULL TEXT
MORBIDITY AND MORTALITY PROFILE OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS WITH AND WITHOUT HEPATITIS C CO-INFECTION
MAYOR et al.
Am J Trop Med Hyg 2006;74:239-245.
ABSTRACT
| FULL TEXT
Management of HIV Infection in Persons Co-infected With Hepatitis
Boston and Slish
Journal of Pharmacy Practice 2005;18:295-309.
ABSTRACT
Therapeutic Drug Monitoring: Role for a Pharmacist in Multidisciplinary Antiretroviral Management
Slish et al.
Journal of Pharmacy Practice 2005;18:310-321.
ABSTRACT
Interaction between HIV-1 and HCV infections: towards a new entity?
Winnock et al.
J Antimicrob Chemother 2004;53:936-946.
ABSTRACT
| FULL TEXT
Chronic HCV Infection in HIV-Positive Patients: A New Challenge
Fuster and Clotet
J Int Assoc Physicians AIDS Care (Chic Ill) 2003;2:56-58.
|
