title: Effect of hepatitis C virus on immunological and virological responses in HIV-infected patients initiating highly active antiretroviral therapy: a meta-analysis.
abstract: Co-infection of human immunodeficiency virus (HIV) with hepatitis C virus (HCV) is rather common. In the era of highly active antiretroviral therapy (HAART), viral hepatitis could result in adverse outcomes in HIV+ patients. The current meta-analysis aims to evaluate the impact of HCV on immunological and virological responses after HAART initiation in HIV/HCV co-infected individuals by synthesizing the existing scientific evidence. A comprehensive search of electronic databases was performed. Eligible studies were analysed using univariate and multivariate meta-analytic methods. Totally, 21 studies involving 22533 individuals were eligible. The estimated summary difference in CD4 cell counts increase between HIV and HIV/HCV co-infected subjects after 3-12 months on HAART was 34.86 cells/mm(3) [95% confidence interval (CI): 16.82-52.89]. The difference was more prominent in patients with baseline CD4 counts below 350 cells/mm(3) (38.97, 95% CI: 20.00-57.93) and attenuated 2 years later (13.43, 95% CI: 0.83-26.04). The analysis of ratio measures yielded similar findings. The virological control remained unaffected by the presence of HCV (adjusted Hazard Ratio for co-infected patients vs those with HIV alone: 0.99, 95% CI: 0.91-1.07). The bivariate meta-analytic method confirmed the results of the univariate approaches. This meta-analysis supports the adverse effect of HCV on immune recovery of HIV+ patients initiating HAART, especially of those with initially impaired immunologic status. Although this effect diminishes over time, early administration of HAART in the setting of co-infection seems to be justified.
authors.affiliation: Hellenic Centre for Disease Control and Prevention, Athens, Greece.
authors.forename: C G
authors.initials: CG
authors.lastname: Tsiara
authors.forename: G K
authors.initials: GK
authors.lastname: Nikolopoulos
authors.forename: N L
authors.initials: NL
authors.lastname: Dimou
authors.forename: P G
authors.initials: PG
authors.lastname: Bagos
authors.forename: G
authors.initials: G
authors.lastname: Saroglou
authors.forename: E
authors.initials: E
authors.lastname: Velonakis
authors.forename: A
authors.initials: A
authors.lastname: Hatzakis
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006526:Hepatitis C / Q000821:virology*; D006801:Humans; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HCV; HIV; antiretroviral treatment; immunological response; virological response