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.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D006526:Hepatitis C / Q000097:blood / Q000150:complications / Q000209:etiology / Q000276:immunology*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D014766:Viremia / Q000097:blood / Q000188:drug therapy
D019380:Anti-HIV Agents; D018937:Hepatitis C Antibodies; D012367:RNA, Viral