title: Changes in HIV RNA and CD4 cell count after acute HCV infection in chronically HIV-infected individuals.
abstract: OBJECTIVE
  Little is known about the impact of acute hepatitis C virus (HCV) co-infection on HIV-1 disease progression. We investigated CD4 cell count and HIV RNA concentration changes after HCV infection in individuals chronically infected with HIV-1.
  
  
  METHODS
  We selected individuals that had the last negative and first positive HCV RNA test less than 1 year apart. Bivariate linear mixed-effects regression was used to model trends in HIV RNA level and CD4 cell count from 2 years before the last negative HCV RNA test until the first of the following dates: start of anti-HCV medication, change in combination antiretroviral therapy (cART) status, and end of follow-up.
  
  
  RESULTS
  At the estimated time of HCV co-infection, of 89 individuals, 63 (71%) were cART-treated and 26 (29%) were not on cART. In persons on cART, median CD4 cell count declined from 587 to 508 cells per cubic millimeter (P < 0.0001) during the first 5 months after HCV infection and returned to 587 cells per cubic millimeter after 2.2 years. Also, the probability of an HIV RNA >50 copies per milliliter peaked to 18.6% at HCV co-infection, with lower probabilities 6 months before (3.5%, P = 0.006 compared with peak probability) and after (2.9%, P = 0.009). In persons not on cART, no significant impact of HCV co-infection on trends in the HIV RNA level or CD4 cell count was observed.
  
  
  CONCLUSIONS
  Acute HCV infection in cART-treated, chronically HIV-infected patients was associated with a temporary decrease in CD4 cell counts and increased risk of HIV viremia >50 copies per milliliter. This may increase the risk of further HIV transmission.
authors.affiliation: *Stichting HIV Monitoring, Amsterdam, the Netherlands; †Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London, United Kingdom; ‡Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre of the University of Amsterdam, Amsterdam, the Netherlands; §Cluster of Infectious Diseases, Department of Research, Public Health Service of Amsterdam, Amsterdam, the Netherlands; ‖Department of Medical Microbiology, Section of Clinical Virology, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands; and ¶Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre of the University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Luuk
authors.initials: L
authors.lastname: Gras
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.forename: Jan T M
authors.initials: JT
authors.lastname: van der Meer
authors.forename: Joost W
authors.initials: JW
authors.lastname: Vanhommerig
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Janke
authors.initials: J
authors.lastname: Schinkel
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral