Background:  Infection with hepatitis C is common among HIV⁺ women.  Viral clearance occurs in 20 to 50% of HCV-infected women, but less frequently among those infected with HIV.   

Methods:  HIV⁺ women co-infected with HCV (n = 352) and AIDS-free at entry into the Women’s Interagency HIV-1 Study (WIHS) were assessed for HCV viremia at baseline and at 6-month follow-up using PCR (COBAS AMPLICOR quantitative PCR followed by qualitative PCR for negatives). Univariate and multivariate analyses were performed to assess for predictors of presence and level of HCV viremia.  Upper and lower 25th percentiles defined low and high HCV RNA.

Results:  Almost 80% of women were HCV viremic and 20% had apparent viral clearance; 58% had RNA levels >1x10⁶ IU/mL and 10% were >5x10⁶ IU/mL. (Median: 1.5x10⁶; range 0 to 38.1x10⁶).  Biologic variability between study visits was < 1.0 log₁₀ HCV RNA in 95% of patients.  In unadjusted analyses HCV viremia was associated with injection drug use (IDU), smoking, CD4 count, CD8 count, HIV RNA level, AST, and alkaline phospatase.  However, after adjusting for significant covariates only IDU [OR 3.78, 95% CI: 1.73 to 8.26, p = 0.0009], elevated AST levels [OR 6.12, 95%CI: 3.11-12.04,  p < 0.0001], and high HIV RNA levels were associated with HCV viremia. Women with >55,000 copies/mL HIV RNA were nearly 3 times more likely to be HCV viremic (OR:3.82, 95%CI: 1.55 to 9.44, p = 0.0093).  Among HCV viremic women (n = 280), level of HCV was associated with HIV therapy, CD4 count, HIV RNA levels, AST, and alkaline phosphatase in unadjusted analyses.  However, after adjusting for CD4 count and HIV RNA level, only AST (p = 0.0016) and alkaline phosphatase (p = 0.0329) remained significantly associated with HCV RNA level.  Further, in multivariate analysis, women who had the highest HCV RNA levels (>3.85 x10⁶ IU/mL) were more likely to have high AST levels (adjusted OR 2.94, 95% CI: 1.36 to 6.35,  p = 0.006), low CD4 counts (per 100 cell/mL: adjusted OR 1.45, 95%CI: 1.20 to 1.75,  p = 0.0001), and high CD8 counts (per 100 cell/mL; adjusted OR 1.16, 95% CI:  1.04 to 1.30,  p = 0.0075) compared to women with low HCV RNA (<0.90x106 IU/mL).  

Conclusions: HCV viremia is strongly associated with IDU, while both level of HIV replication and immunologic stage affects level of HCV viremia. These results suggest that re-infection and/or reactivation of HCV may occur in HIV⁺ women, especially with advancing immunologic stage of HIV disease.

Keywords: Coinfection; Injection drug use; Reactivation