title: Impact of hepatitis C on HIV progression in adults with alcohol problems.
abstract: BACKGROUND
  Coinfection of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a substantial medical and public health concern due to its increasing prevalence and complex patient management. Alcohol use may worsen HCV-related liver disease and interfere with adherence to antiretroviral therapy (ART) and medical care. We therefore studied the association between HCV infection and markers of HIV disease progression in adults with alcohol problems.
  
  
  METHODS
  This is a longitudinal study of 396 HIV-infected persons with alcohol problems, 199 (50%) of whom were coinfected with HCV (positive HCV RNA test). CD4 cell counts and HIV RNA levels were assessed at baseline and then every 6 months for up to 42 months. Hepatitis C virus RNA status was determined at study enrollment. We examined the relationship between HCV infection and laboratory markers of HIV progression (CD4 cell count and log10 HIV RNA) by fitting multivariable longitudinal regression models for each outcome.
  
  
  RESULTS
  Among subjects who were adherent to ART, the presence of HCV infection was associated with a lower CD4 cell count (adjusted mean difference -46.0 cells/microL, p=0.03). There was no association observed between HCV infection and CD4 cell count among those not adherent to ART or those not taking ART. No significant association was observed between HCV infection and HIV RNA regardless of ART status.
  
  
  CONCLUSIONS
  Hepatitis C virus infection has an adverse effect on CD4 cell count in patients with alcohol problems who are adherent to ART. Addressing HCV coinfection among these patients may confer additional immunologic benefit for this patient population.
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA. dmcheng@bu.edu
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: David
authors.initials: D
authors.lastname: Nunes
authors.forename: Howard
authors.initials: H
authors.lastname: Libman
authors.forename: John
authors.initials: J
authors.lastname: Vidaver
authors.forename: Julie K
authors.initials: JK
authors.lastname: Alperen
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D000437:Alcoholism / Q000150:complications*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D012044:Regression Analysis; D012309:Risk-Taking; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D012367:RNA, Viral