title: Relationship of chronic hepatitis C infection to rates of AIDS-defining illnesses in a Canadian cohort of HIV seropositive individuals receiving highly active antiretroviral therapy.
abstract: BACKGROUND
  The influence of chronic hepatitis C virus (HCV) infection on the risk, timing, and type of AIDS-defining illnesses (ADIs) is not well described. To this end, rates of ADIs were evaluated in a Canadian cohort of HIV seropositive individuals receiving highly active antiretroviral therapy (HAART).
  
  
  METHODS
  ADIs were classified into 6 Centers for Disease Control and Prevention (CDC)-defined etiological subgroups: non-Hodgkin lymphoma, viral infection, bacterial infection, HIV-related disease, protozoal infection, and mycotic infection. Generalized estimating equation (GEE) Poisson regression models were used to estimate the effect of HCV on rates of ADIs after adjusting for covariates.
  
  
  RESULTS
  Among 2,706 HAART recipients, 768 (28%) were HCV coinfected. Rates of all ADIs combined and of bacterial infection, HIV-related disease, and mycotic infection were increased in HCV-coinfected persons and among those with CD4 counts <200 cells/mm3 HCV was associated with an increased risk of ADIs (rate ratio [RR], 1.38; 95% CI, 1.01-1.88) and a 2-fold increased risk of mycotic infections (RR, 2.21; 95% CI, 1.35-3.62) in univariate analyses and after adjusting for age, baseline viral load, baseline CD4 count, and region of Canada. However, after further adjustment for HAART interruptions, HCV was no longer associated with an increased rate of ADIs overall (RR, 1.13; 95% CI, 0.80-1.59), but remained associated with an increased rate of mycotic infections (RR, 1.97, 95% CI, 1.08-3.61).
  
  
  CONCLUSIONS
  Although HCV coin-fected individuals are at increased risk of developing ADIs overall, our analysis suggests that behavioral variables associated with HCV (including rates of retention on HAART), and not biological interactions with HCV itself, are primarily responsible.
authors.affiliation: University Health Network, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Raboud
authors.forename: A
authors.initials: A
authors.lastname: Anema
authors.forename: D
authors.initials: D
authors.lastname: Su
authors.forename: M B
authors.initials: MB
authors.lastname: Klein
authors.forename: A
authors.initials: A
authors.lastname: Zakaryan
authors.forename: T
authors.initials: T
authors.lastname: Swan
authors.forename: A
authors.initials: A
authors.lastname: Palmer
authors.forename: S
authors.initials: S
authors.lastname: Hosein
authors.forename: M R
authors.initials: MR
authors.lastname: Loutfy
authors.forename: N
authors.initials: N
authors.lastname: Machouf
authors.forename: J S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: S B
authors.initials: SB
authors.lastname: Rourke
authors.forename: C
authors.initials: C
authors.lastname: Tsoukas
authors.forename: R S
authors.initials: RS
authors.lastname: Hogg
authors.forename: C
authors.initials: C
authors.lastname: Cooper
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D019380:Anti-HIV Agents