The effect of hepatitis C on progression to AIDS before and after highly active antiretroviral therapy.
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.
Dorrucci
Maria
M
Centro Operativo AIDS, Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto Superiore di Sanità, Rome, Italy. maria.dorrucci@iss.it
Valdarchi
Catia
C
Suligoi
Barbara
B
Zaccarelli
Mauro
M
Sinicco
Alessandro
A
Giuliani
Massimo
M
Vlahov
David
D
Pezzotti
Patrizio
P
Rezza
Giovanni
G
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