833 Hepatitis C Virus Load Measured Prior to HIV Seroconversion is not Associated with Subsequent HIV Disease Progression in Injection Drug Users M. S. Sulkowski*1, J. Astemborski1, D. Vlahov1,2, S. A. Strathdee1, D. L. Thomas1 1Johns Hopkins Univ, Baltimore, MD and 2New York Academy of Med, New York
Background: In some studies, the serum hepatitis C virus (HCV) RNA level determined after HIV seroconversion has been associated with progression to AIDS/death. However, the relationship of the HCV RNA level prior to HIV seroconversion (SC) and subsequent HIV disease progression is unknown.
Methods: HIV disease progression and survival were analyzed in a prospective, cohort of active/former injection drug users (IDUs) followed semi-annually in Baltimore, MD (the ALIVE cohort). HCV-antibody-positive, HIV antibody-negative persons who acquired HIV infection before 1/1997 were studied using longitudinal data, including blood tests, clinical outcomes (e.g., AIDS and death). Cox regression was used to assess time to AIDS-related death, progression to AIDS-defining illness (first OI), and to CD4 < 200/µL.
Results: We analyzed 225 HCV seropositive, HIV seroconverters: male, 76%; median age at HIV SC, 35.9 yrs (IQR 31.4-40.4); Black, 94%; median duration of IDU prior to HIV SC, 11.8 yrs (IQR 4.7-18.8); median initial CD4 cell count, 647/µL (IQR 449-894); median initial HIV RNA level, 31,339 c/mL (IQR 7,699-8,6484). HCV RNA levels were obtained a median of 9.3 months (IQR 6.9-12.3) prior to HIV SC. The median HCV RNA level was 40,100 eq/mL (IQR 1,550-257,000). The median duration of follow-up was 4.9 yrs (IQR 3.5-7.4), during which time only 11% received HAART. Progression to AIDS, AIDS-related death ,and CD4 cell count < 200/µL was observed in 53 persons (24.6%), 31 persons (13.7%), and 104 persons (46.6%), respectively. HCV RNA level determined before HIV SC was not associated with progression to AIDS (HR 1.07, 95% CI, 0.84-1.34), AIDS-related death (HR 1.16, 95% CI, 0.85-1.58), or CD4 cell count < 200/µL (HR 1.11, 95% CI, 0.95-1.30).
Conclusions: In this cohort, the HCV RNA level measured prior to HIV seroconversion was not associated with subsequent progression to AIDS, AIDS-related death, or CD4 cell decline. Further research is needed to determine the relationship of hepatitis C infection and HIV disease progression.
