title: GB virus C during the natural course of HIV-1 infection: viremia at diagnosis does not predict mortality.
abstract: OBJECTIVE
  To investigate whether GBV-C viremia at diagnosis of HIV-1 infection predicts disease outcome in patients not receiving combination antiretroviral therapy (ART), and whether longitudinal changes in GBV-C viremia are associated with disease progression.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  230 patients with a serum sample available for testing obtained within 2 years of HIV-1 diagnosis were followed until either initiation of ART, death, or their last visit to our clinic (median follow-up 4.3 years). Baseline and follow-up serum samples (available from 163 patients) were tested for GBV-C RNA and antibodies against GBV-C envelope E2 protein (anti-E2; signifying resolved GBV-C viremia).
  
  
  RESULTS
  At inclusion, 62 patients (27%) had GBV-C viremia and 69 (30%) had anti-E2. Baseline GBV-C status was not associated with all-cause mortality (P = 0.12), HIV-related mortality (P = 0.18), or development of AIDS (P = 0.84). However, GBV-C RNA was less prevalent in patients with AIDS at inclusion (P = 0.008). Eleven of 44 patients with baseline GBV-C viremia lost GBV-C RNA during follow-up without showing anti-E2 seroconversion. In comparison with anti-E2-negative patients with either persistent absence, persistent presence, or acquisition of GBV-C viremia, these subjects had significantly increased all-cause mortality (P = 0.018), HIV-related mortality (P = 0.007), and AIDS incidence (P < 0.001).
  
  
  CONCLUSIONS
  GBV-C status at diagnosis did not predict disease outcome in this HIV cohort. GBV-C viremia was rare in patients with AIDS, and tended to disappear without occurrence of anti-E2 in patients with progressive disease. This suggests that the GBV-C status of HIV-1-infected patients could be a phenomenon secondary to HIV progression, rather than an independent prognostic factor.
authors.affiliation: Department of Infectious Diseases and Department of Medical Microbiology, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Björkman
authors.forename: Leo
authors.initials: L
authors.lastname: Flamholc
authors.forename: Anders
authors.initials: A
authors.lastname: Nauclér
authors.forename: Vilma
authors.initials: V
authors.lastname: Molnegren
authors.forename: Ewa
authors.initials: E
authors.lastname: Wallmark
authors.forename: Anders
authors.initials: A
authors.lastname: Widell
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D005260:Female; D018178:Flaviviridae Infections / Q000150:complications* / Q000401:mortality; D005500:Follow-Up Studies; D029407:GB virus C / Q000235:genetics / Q000276:immunology; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality; D015497:HIV-1 / Q000276:immunology; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000276:immunology / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D014766:Viremia
chemical_list: D019380:Anti-HIV Agents; D000914:Antibodies, Viral; D012367:RNA, Viral