title: The Impact of HCV Infection Duration on HIV Disease Progression and Response to cART amongst HIV Seroconverters in the UK.
abstract: BACKGROUND
  The effect of HCV infection on HIV disease progression remains unclear; the effect of HCV infection duration on HIV disease progression is unknown.
  
  
  METHODS
  We used data from a cohort of HIV seroconverters to investigate the effect of HCV infection duration on time from HIV seroconversion to CD4 <350 cells/mm3, AIDS or death, censoring at the earlier of cART initiation or last clinic visit, adjusting for confounders and splitting data into follow up periods from HIV seroconversion (<2, 2-4 and >4 years). We additionally compared CD4 cell decline following HCV infection to that of mono-infected individuals with similar HIV infection duration by fitting a random effects model. In a separate analysis, we used linear mixed models to we examine the effect of HCV infection and its duration on CD4 increase over 48 weeks following cART.
  
  
  RESULTS
  Of 1655 individuals, 97 (5.9%) were HCV co-infected. HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2-4 and >4 years respectively), compared to mono-infected individuals. However, we found no evidence of an association for those with HCV>2 years (all p>0.89). Individuals experienced a somewhat greater decrease in CD4 count following HCV infection lasting 13 months, relative to individuals with HIV alone, (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45).
  
  
  CONCLUSIONS
  The impact of HCV co-infection on HIV disease progression appears to be restricted to the first year after HCV infection.
authors.affiliation: MRC Clinical Trials Unit at University College London, London, United Kingdom.
authors.forename: Jamie
authors.initials: J
authors.lastname: Inshaw
authors.affiliation: Western General Hospital, Edinburgh, United Kingdom.
authors.forename: Clifford
authors.initials: C
authors.lastname: Leen
authors.affiliation: Brighton and Sussex University NHS Trust, Brighton, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
authors.affiliation: Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hawkins
authors.affiliation: HIV i-Base, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.affiliation: Guy's and St. Thomas NHS Trust at Kings College, London, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Fox
authors.affiliation: Charing Cross Hospital, London, United Kingdom.
authors.forename: Ken
authors.initials: K
authors.lastname: McLean
authors.affiliation: Imperial College NHS Trust, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fidler
authors.affiliation: Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.affiliation: Public Health England, London, United Kingdom.
authors.forename: Sam
authors.initials: S
authors.lastname: Lattimore
authors.affiliation: MRC Clinical Trials Unit at University College London, London, United Kingdom.
authors.forename: Abdel
authors.initials: A
authors.lastname: Babiker
authors.affiliation: MRC Clinical Trials Unit at University College London, London, United Kingdom.
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy* / Q000276:immunology; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents