title: Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status.
abstract: Hepatitis C virus (HCV) co-infection and biological sex may each affect response to antiretroviral therapy (ART), yet no studies have examined HIV-associated outcomes by both HCV status and sex. We conducted a cohort study of HIV-infected adults initiating ART in Kaiser Permanente California during 1996-2011. We used piecewise linear regression to assess CD4 changes by sex and HCV status over 5 years. We used Cox regression to estimate hazard ratios (HR) by sex and HCV status for HIV RNA <500 copies/mL over 1 year, and for AIDS and death over the follow-up period. Among 12,865 subjects, there were 154 HIV/HCV-co-infected women, 1000 HIV/HCV-co-infected men, 1088 HIV-mono-infected women, and 10,623 HIV-mono-infected men. CD4 increases were slower in the first year for HIV/HCV-co-infected women (75 cells/μL) and men (70 cells/μL) compared with HIV-mono-infected women (145 cells/μL) and men (120 cells/μL; p<0.001). After 5 years, women had higher CD4 than men in both HIV-mono-infected (598 vs. 562 cells/μL, p=0.003) and HIV/HCV-co-infected individuals (567 vs. 509 cells/μL, p=0.003). Regardless of sex, HIV/HCV co-infection was associated with 40% higher mortality [95% confidence interval (CI): 1.2-1.6] compared with HIV mono-infection, but was not associated with AIDS (HR 1.1, 95% CI: 0.9-1.3) or achieving HIV RNA <500 copies/mL (HR 1.0, 95% CI: 0.9-1.1). HIV/HCV-co-infected men and women have slower CD4 recovery after starting ART and have increased mortality compared with HIV-mono-infected men and women. HCV should be aggressively treated in HIV/HCV-co-infected adults, regardless of sex.
authors.affiliation: 1 Kaiser Permanente Northern California , Oakland, California.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Marcus
authors.affiliation: 1 Kaiser Permanente Northern California , Oakland, California.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Leyden
authors.affiliation: 2 Kaiser Permanente Southern California , Pasadena, California.
authors.forename: Chun R
authors.initials: CR
authors.lastname: Chao
authors.affiliation: 2 Kaiser Permanente Southern California , Pasadena, California.
authors.forename: Lanfang
authors.initials: L
authors.lastname: Xu
authors.affiliation: 1 Kaiser Permanente Northern California , Oakland, California.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.affiliation: 3 University of California , San Francisco, California, and Department of Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.affiliation: 4 Kaiser Permanente Northern California , San Leandro, California.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Klein
authors.affiliation: 5 Kaiser Permanente Southern California , Los Angeles, California.
authors.forename: William J
authors.initials: WJ
authors.lastname: Towner
authors.affiliation: 6 Mid-Atlantic Permanente Research Institute , Rockville, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.affiliation: 1 Kaiser Permanente Northern California , Oakland, California.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents