Epidemiology

HCV infection and genotype influence disease progression in HIV patients

Last Updated: 2005-01-07 12:31:51 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Hepatitis C virus (HCV) infection and HCV genotype influence the course of HCV and HIV coinfection, according to a report in the January 1, 2005 issue of The Journal of Infectious Diseases.

"We believe that this study supports previous work from our group and others that HCV infection does influence the natural history of HIV disease and that further defining this interaction may provide additional rationale for HCV treatment in co-infected individuals," Dr. Eric S. Daar from the David Geffen School of Medicine, University of California at Los Angeles told Reuters Health.

Dr. Daar and associated in the Hemophilia Growth and Development Study investigated the relationship between HCV genotype and HCV viremia, markers of HIV disease, and clinical progression of HIV disease in 207 HIV-1-infected and 126 HIV-1-uninfected children and adolescents with hemophilia.

HIV-infected patients were more likely than HIV-uninfected patients to be infected with HCV genotype 1, the authors report, and the mean HCV RNA level was higher among those with HCV genotype 1, whether or not they were coinfected with HIV.

CD4+ T cell counts and percentages at baseline were significantly lower among HIV-infected patients who also had HCV genotype 1, compared with HCV non-genotype 1 patients, but HIV RNA levels at baseline did not differ by HCV genotype, the results indicate.

Although the risk of progression to clinical AIDS did not differ by HCV genotype, the investigators note, the risk for progression to AIDS-related mortality during follow-up was greater in patients with HCV genotype 1 than in patients with HCV non-genotype 1.

The hazard ratio for progression to AIDS-related mortality remained around 2.25 in the HCV genotype 1 group (compared with the HCV non-genotype 1 group) even after adjustment for age and baseline viral load (HCV or HIV), the report indicates.

"We are in the process of considering further studies to better understand why HCV genotype 1 might be associated with accelerated HIV disease," Dr. Daar said. "This area of research is sufficiently controversial and HCV therapy remains problematic; therefore, more work is clearly needed before any strong statements can be made to physicians managing HIV and HCV-infected individuals in the clinic."

"In general, I recommend that people with HCV genotype 1 and HIV, particularly if they have transaminase elevations, undergo a liver biopsy," Dr. Daar added. "If there is active disease, counsel them about the risks and potential benefits of therapy, as well as the risks associated with untreated HCV infection."

"The issue of a worsened AIDS-related mortality in HIV/HCV genotype 1-coinfected patients has important clinical implications," write Dr. Marina Nunez and Dr. Vincent Soriano from Hospital Carlos III, Madrid in a related commentary. "It provides further reason for treating hepatitis C in [such] patients, even though sustained virological response rates are achieved in less than 30% of HIV/HCV genotype 1-coinfected patients receiving pegylated interferon and ribavirin."

J Infect Dis 2005;191:1-10.