title: The effect of hepatitis C on progression to AIDS before and after highly active antiretroviral therapy.
abstract: OBJECTIVE
  To assess the effect of infection with hepatitis C virus (HCV) on the progression of human immunodeficiency virus (HIV) disease, before and after the introduction of highly active antiretroviral therapy (HAART).
  
  
  METHODS
  We used data from a multi-centre prospective study of HIV seroconverters. Survival analyses were performed to compare the progression to AIDS by HCV serostatus in the period before HAART (i.e. June 1991-May 1996) and in the HAART era (i.e. June 1996-June 2001), controlling for duration of HIV infection.
  
  
  RESULTS
  Among the 1052 persons enrolled, 595 (56.6%) were co-infected; the median follow-up time was 9.7 years. Adjusting for demographic variables (age at HIV seroconversion and gender), HCV infection had no effect on the progression to AIDS in the pre-HAART era [relative hazard (RH) = 0.84; 95% confidence interval (CI), 0.63-1.11], whereas it increased the risk in the HAART era (RH = 1.77; 95% CI, 1.15-2.73). In the HAART era, the proportion of person-time spent on HAART out of the total time at risk was significantly lower among co-infected persons (30 versus 40% for non-co-infected persons; P-value = 0.001); no significant difference was found for dual-therapy (29 versus 25%, respectively; P-value = 0.205); a significant difference was found for mono-therapy (15 versus 8%, respectively; P-value < 0.001).
  
  
  CONCLUSIONS
  HCV infection was not a determinant of HIV disease progression in the pre-HAART era, whereas since the introduction of HAART, co-infected individuals seem to have had a faster disease progression. This may in part be explained by differences in person-time spent on different antiretroviral regimens.
authors.affiliation: Centro Operativo AIDS, Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto Superiore di Sanità, Rome, Italy. maria.dorrucci@iss.it
authors.forename: Maria
authors.initials: M
authors.lastname: Dorrucci
authors.forename: Catia
authors.initials: C
authors.lastname: Valdarchi
authors.forename: Barbara
authors.initials: B
authors.lastname: Suligoi
authors.forename: Mauro
authors.initials: M
authors.lastname: Zaccarelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sinicco
authors.forename: Massimo
authors.initials: M
authors.lastname: Giuliani
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pezzotti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rezza
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology*; D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000276:immunology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors