1069 
HCV Co-infection Does Not Influence the CD4 Cell Recovery in HIV-1-infected Patients with Maximum Virologic Suppression: EuroSIDA Cohort
Lars Peters*1, A Mocroft2, V Soriano3, J Rockstroh4, P Aldins5, M Losso6, L Valerio7, P Reiss8, B Ledergerber9, J Lundgren1, and The EuroSIDA Study Group
1Copenhagen HIV Prgm, Univ of Copenhagen, Denmark; 2Royal Free and Univ Coll Med Sch, London, UK; 3Hosp Carlos III, Madrid, Spain; 4Univ of Bonn, Germany; 5Infectology Ctr of Latvia, Riga; 6Hosp JM Ramos Mejia, Buenos Aires, Argentina; 7Ctr Hosp Univ Nice, Hosp de l`Archet, France; 8Academic Med Ctr, Amsterdam, The Netherlands; and 9Univ Hosp Zurich, Switzerland
Background: Conflicting data exist as to whether hepatitis
C virus (HCV) affects the CD4 cell recovery in HIV patients starting ART. We
aimed to investigate the influence of HCV co-infection on the CD4 cell recovery
in patients with maximum virologic suppression within the EuroSIDA cohort.
Methods: We included all patients tested for anti-HCV
antibodies and who had at least 2 consecutive readings for HIV viral load
<50 copies/mL after starting combination ART (cART). cART was defined as a
minimum of 3 drugs, of which at least 2 were nucleos(t)ides. Baseline was
defined as the first of 2 consecutive viral loads <50 mL after starting
cART. For each pair of viral loads <50 copies/mL, the annual change in CD4
count was calculated and 3 comparisons made: HCV-seronegative vs
HCV-seropositive patients; comparison between genotypes 1-4 in HCV RNA+
patients; among HCV-seropositive patients, comparison of those viremic vs
aviremic (HCV RNA <615 IU/mL); results were adjusted for nucleoside pair,
third drug, age, time and change in CD4 since starting cART, time to initial
virologic suppression <500 copies/mL, and whether the patient was treatment
naive at starting cART.
Results: The 3892 patients we included represented 34,178
pairs of HIV viral load measurements of <50 copies/mL and 10,422 person-years
of follow up; 809 (21%) patients were HCV-seropositive and among them 621 (77%)
had detectable HCV RNA. Median time between HIV viral load pairs was 94 days
(IQR 84 to 124) and median number of pairs per person 7 (IQR 4 to 12). The
unadjusted annual change in CD4 count for HCV-seropositive and -seronegative
patients was 42.1 cells/mL (95%CI 33.2 to
51.0) and 40.8 cells/mL (95%CI 36.8 to
44.7), respectively. After adjustment there was no difference in annual CD4
change when comparing according to HCV serostatus (p = 0.48), between
genotypes (p = 0.51), or when comparing HCV viremic vs aviremic (p
= 0.78). Adjusting additionally for HCV treatment and HCV RNA viral load did
not change the findings.
Conclusions: In EuroSIDA, HCV serostatus did not influence
the CD4 cell recovery in HIV patients with maximum virologic suppression after
starting cART. Furthermore, no difference in CD4 cell gain was found when
comparing distinct HCV genotypes in HCV RNA+ patients or when comparing
HCV viremic and aviremic patients in HCV-seropositive patients.
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