title: Impact of GB virus C viraemia on clinical outcome in HIV-1-infected patients: a 20-year follow-up study.
abstract: OBJECTIVE
  The impact of coexisting GB virus C (GBV-C) infection on the clinical course of HIV infection remains controversial. Early data from HIV-1 infected patients attending the Hannover Medical School in 2001 suggested prognostic benefit in GBV-C viraemic patients. The aim of this study was to evaluate patterns in long-term mortality and morbidity outcomes in this cohort. The impact of the introduction of antiretroviral therapy (ART) on the perceived benefits of GBV-C viraemia was subsequently investigated.
  
  
  METHODS
  A retrospective follow-up analysis of data in this cohort was performed. GBV-C status (GBV-C RNA positive, antibodies against GBV-C envelope protein E2 or no evidence of GBV-C exposure) had been determined at enrolment, with several markers of HIV disease progression (such as viral load and CD4 cell count) being collated from 1993/1994, 2000 and 2012. These eras were chosen to reflect variations in treatment strategies within the cohort. In addition, mortality and HIV-related morbidity data were collated for all patients.
  
  
  RESULTS
  Complete data were available for 156 of 197 patients (79%). In highly active antiretroviral therapy (HAART)-naïve patients, GBV-C RNA positivity conferred significant improvements in the course of HIV infection and mortality as well as lower rates of HIV-related diseases. E2 positivity alone conferred no significant advantage. With the advent of HAART, however, the benefits GBV-C RNA positivity disappeared.
  
  
  CONCLUSIONS
  Although GBV-C coinfection appears to inherently improve morbidity and mortality in HIV-infected patients, modern HAART has eradicated these advantages. Evidence of synergy between GBV-C status and HAART response exists, with further studies examining the role of GBV-C in existing treatment de-escalation strategies being required.
authors.affiliation: Department of Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Ernst
authors.forename: M
authors.initials: M
authors.lastname: Greer
authors.forename: R
authors.initials: R
authors.lastname: Akmatova
authors.forename: S
authors.initials: S
authors.lastname: Pischke
authors.forename: H
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: H
authors.initials: H
authors.lastname: Heiken
authors.forename: H L
authors.initials: HL
authors.lastname: Tillmann
authors.forename: R E
authors.initials: RE
authors.lastname: Schmidt
authors.forename: M
authors.initials: M
authors.lastname: Stoll
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D060085:Coinfection; D005260:Female; D018178:Flaviviridae Infections / Q000150:complications / Q000401:mortality*; D005500:Follow-Up Studies; D029407:GB virus C / Q000235:genetics / Q000276:immunology / Q000502:physiology*; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D014759:Viral Envelope Proteins / Q000276:immunology; D014766:Viremia / Q000150:complications / Q000401:mortality
chemical_list: D012367:RNA, Viral; D014759:Viral Envelope Proteins; C107619:glycoprotein E2, GB virus C
keywords: GBV-C virus; HIV; antiretroviral treatment