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Session 84 Poster Session HCV Co-Infection and HIV/HCV Immune Responses Session Time: 4:30-6:30 pm Room 4E-F

639-M. Poorer Immunological Response to HAART in HIV+ Individuals Co-Infected with Hepatitis C Virus C. Sabin*1, B. Dauer2, A. N. Phillips1, T. Lutz2, V. Miller2, A. Cozzi Lepri1, and S. Staszewski2 1Royal Free and Univ. Coll. Med. Sch., London, UK and 2Clin. der J. W. Goethe Univ., Frankfurt, Germany Background: Studies have suggested that individuals co-infected with HCV have a similar virological response to HAART but a poorer immunological response than those who are HCV-ve. The aim of this study was to describe the effect of HCV infection on virological and immunological responses to HAART in 576 patients attending an HIV clinic in Frankfurt. Methods: Patients were followed from the date of starting HAART (the first regimen including a PI or NNRTI) to the date of virological (first HIV RNA <500 copies/mL) or immunological (100 cell/mm3 increase in CD4 from pre-HAART levels) response. Cox regression models were used to assess the effects of HCV antibody status and other factors on these responses. Results: Patients started HAART between 1996-2001, 76% were male, and the main risk factors for HIV infection were homo/bisexual sex (45%), injecting drug use (IDU) (15%), and heterosexual sex (27%). 69% were ARV-naïve. The median CD4 count and HIV RNA level were 164 cells/mm3 and 5.2 log10 copies/mL. 120 patients (21%) were HCV+ve. HCV+ve patients were more likely to be female (p=0.006), to report IDU as their risk for HIV infection (p=0.006), had been infected with HIV for longer (p=0.0001), were less likely to be ARV-naïve (p=0.03), and more likely to start a NNRTI (p=0.004) than HCV-ve patients. 90% and 79% of patients experienced a virological and immunological response. In univariate analyses, HCV+ve patients were less likely to achieve a virological response than HCV-ve patients (RH 0.74, p=0.007), but this was not significant after adjusting for baseline HIV RNA and previous treatment. In contrast, HCV+ve patients were less likely to experience an immunological response in univariate analyses (RH 0.64, p=0.002) and after adjusting for other baseline factors (RH 0.61, p=0.001). HCV+ve patients had less frequent CD4 monitoring after HAART (median time between CD4 measures: 48 and 42 days in HCV+ves and HCV-ves), but the effect of HCV status remained significant after adjusting for this. Conclusions: Individuals infected with HCV have a poorer immunological response to HAART than those who are HCV-ve, despite having similar virological responses. Whilst the confounding between risk group and HCV status means that it is difficult to fully adjust for risk group, the effect of HCV status appears to be independent of other baseline factors, such as HIV RNA, and is independent of the frequency of CD4 monitoring.

©2002 9th Conference on Retroviruses and Opportunistic Infections