Background:  The impact of hepatitis C virus (HCV) on HIV-related immune reconstitution and viral control after initiation of ART is controversial. In North America and Europe, injection drug use (IDU) is a common route of acquisition for both HIV and HCV and may also impact HIV control and ART tolerability. We examined a cohort of ART-naοve, non-IDU patients in Nigeria to determine the effects of HCV on HIV parameters without IDU as a confounder.

Methods:  Patients with HIV initiating stavudine, lamivudine, and nevirapine were tested for HCV antibody (HCV⁺) and hepatitis B surface antigen (HBV⁺). This study compared subjects who were HCV⁺/HBV^– to those who were HCV^–/HBV^–. Follow-up was for 6 months after ART initiation. Hepatotoxicity was defined as ALT values 5 times the upper limit of normal (ULN; 41 IU/mL) or 3.5 times baseline alanine aminotransferase (ALT) if ALT was above ULN at baseline. Nonparametric tests were used to compare groups.

Results:  We tested 1968 subjects for HCV and HBV:  1170 were HCV^–/HBV^– (HIV), 271 were HCV⁺/HBV^– (HIV/HCV), and 63 were HCV⁺/HBV⁺ (excluded from further analysis).  Median age of HIV/HCV subjects was 38 years compared to 35 years for HIV (p <0.0001) and 37% vs 33% were male, respectively (p = 0.18). Median CD4 count (cells/mm³) at baseline was 119 for HIV/HCV vs 132 for HIV, respectively, and at months 3 and 6, CD4 counts increased to 243 vs 237 and 242 vs 247 for HIV/HCV vs HIV patients, respectively (p >0.05). Median HIV viral load (copies/mL) at baseline was 71,451 for HIV/HCV vs 53,278 for HIV (p = 0.11) and at month 6, 72% of HIV/HCV and 76% of HIV patients had HIV viral load <400 (p = 0.32). For patients with baseline and month 6 ALT, mean ALT at baseline was similar (HIV/HCV ALT = 32.5 vs 31.7 in HIV) while at month 6, mean ALT was significantly higher in HIV/HCV (ALT = 41.5) vs HIV (ALT = 30.6, p < 0.003). For subjects with baseline and either month 3 or month 6 ALT values, there was a 2% incidence of hepatotoxicity by month 6 in HIV/HCV compared to 0.3% in HIV (p <0.05). The median age of those with hepatotoxicity was 45 years for HIV/HCV vs 30 years for HIV and 33% of HIV/HCV with hepatotoxicity were females compared to 100% of HIV subjects.

Conclusions:  We found few differences in immune reconstitution or HIV virological control in this non-IDU cohort of HIV/HCV vs HIV patients. Incidence of hepatotoxicity was low in both groups during the first 6 months of ART, although significantly higher in HIV/HCV patients.