title: Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is highly prevalent among HIV-1-infected individuals, but its contribution to the morbidity and mortality of coinfected patients who receive potent antiretroviral therapy is controversial. We used data from the ongoing Swiss HIV Cohort Study to analyse clinical progression of HIV-1, and the virological and immunological response to potent antiretroviral therapy in HIV-1-infected patients with or without concurrent HCV infection.
  
  
  METHODS
  We analysed prospective data on survival, clinical disease progression, suppression of HIV-1 replication, CD4-cell recovery, and frequency of changes in antiretroviral therapy according to HCV status in 3111 patients starting potent antiretroviral therapy.
  
  
  RESULTS
  1157 patients (37.2%) were coinfected with HCV, 1015 of whom (87.7%) had a history of intravenous drug use. In multivariate Cox's regression, the probability of progression to a new AIDS-defining clinical event or to death was independently associated with HCV seropositivity (hazard ratio 1.7 [95% CI 1.26-2.30]), and with active intravenous drug use (1.38 [1.02-1.88]). Virological response to antiretroviral therapy and the probability of treatment change were not associated with HCV serostatus. In contrast, HCV seropositivity was associated with a smaller CD4-cell recovery (hazard ratio for a CD4-cell count increase of at least 50 cells/microL=0.79 [0.72-0.87]).
  
  
  CONCLUSIONS
  HCV and active intravenous drug use could be important factors in the morbidity and mortality among HIV-1-infected patients, possibly through impaired CD4-cell recovery in HCV seropositive patients receiving potent antiretroviral therapy. These findings are relevant for decisions about optimum timing for HCV treatment in the setting of HIV infection.
authors: Division of Infectious Diseases, University Hospital, Lausanne, Switzerland.
authors: G
authors: G
authors: Greub
authors: B
authors: B
authors: Ledergerber
authors: M
authors: M
authors: Battegay
authors: P
authors: P
authors: Grob
authors: L
authors: L
authors: Perrin
authors: H
authors: H
authors: Furrer
authors: P
authors: P
authors: Burgisser
authors: P
authors: P
authors: Erb
authors: K
authors: K
authors: Boggian
authors: J C
authors: JC
authors: Piffaretti
authors: B
authors: B
authors: Hirschel
authors: P
authors: P
authors: Janin
authors: P
authors: P
authors: Francioli
authors: M
authors: M
authors: Flepp
authors: A
authors: A
authors: Telenti
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D013557:Switzerland; D019562:Viral Load; D014766:Viremia / Q000209:etiology
chemical_list: D019380:Anti-HIV Agents