title: Acquisition of GB virus type C and lower mortality in patients with advanced HIV disease.
abstract: BACKGROUND
  GB virus type C (GBV-C) is transmitted by sexual or parenteral exposure and is prevalent among patients receiving blood products. GBV-C is associated with lower human immunodeficiency virus (HIV) RNA and better survival among HIV-infected patients. Open questions are the presence and the direction of any causal relationship between GBV-C infection and HIV disease markers in the context of highly active antiretroviral therapy (HAART).
  
  
  METHODS
  We used a limited access database obtained from the National Heart, Lung, and Blood Institute's Viral Activation Transfusion Study (VATS), a randomized controlled trial of leukoreduced vs nonleukoreduced transfusions to HIV-infected transfusion-naive patients. Blood samples from 489 subjects were tested for GBV-C markers. Cox regression models and inverse probability of treatment weights were used to examine the association between GBV-C coinfection and mortality in the VATS cohort.
  
  
  RESULTS
  We found a significant reduction in mortality among GBV-C coinfected VATS subjects, after adjusting for HAART status, HIV RNA level, and CD4 cell count at baseline. Acquisition of GBV-C RNA (n = 39) was associated with lower mortality in 294 subjects who were GBV-C negative at baseline, adjusting for baseline covariates (hazard ratio = 0.22, 95% confidence interval [CI]: .08-.58) and in models in which weights were used to control for time-updated covariates (odds ratio = 0.21, 95% CI: .08-.60).
  
  
  CONCLUSIONS
  GBV-C viremia is associated with lower mortality, and GBV-C acquisition via transfusion is associated with a significant reduction in mortality in HIV-infected individuals, controlling for HIV disease markers. These findings provide the first evidence that incident GBV-C infection alters mortality in HIV-infected patients.
authors: Blood Systems Research Institute, Epidemiology, San Francisco, CA 94118, USA. fvahidnia@bloodsystems.org
authors: Farnaz
authors: F
authors: Vahidnia
authors: Maya
authors: M
authors: Petersen
authors: Jack T
authors: JT
authors: Stapleton
authors: George W
authors: GW
authors: Rutherford
authors: Michael
authors: M
authors: Busch
authors: Brian
authors: B
authors: Custer
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects; D005260:Female; D018178:Flaviviridae Infections / Q000453:epidemiology* / Q000821:virology; D029407:GB virus C / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis