Background:  Little is known about the effect of chronic hepatitis C (HCV) infection on HIV in Nigeria. We hypothesized that subjects with HCV viremia would have higher incidence of hepatotoxicity than subjects with HIV alone.

Methods:  Subjects with HIV initiating stavudine, lamivudine, and nevirapine were tested for HCV antibody (HCV⁺) and hepatitis B surface antigen (HBV⁺). A subset of HCV⁺ subjects had HCV RNA qualitative assays performed. Subjects who were HCV RNA⁺/HBV^– were compared to HCV^–/HBV^– subjects using nonparametric tests. Follow-up was for 6 months after ART initiation. Hepatotoxicity was defined as alanine aminotransferase (ALT) values 5 times the upper limit of normal (ULN; 41 IU/mL) or 3.5 times baseline ALT if ALT was above ULN at baseline.

Results:  We tested 1968 subjects for HCV and HBV:  1170 were HCV^–/HBV^– (HIV); 396 were HCV⁺, of whom 314 were tested for HCV RNA. Of these 314 subjects, 98 were HCV viremic (31.2%); 13 of 63 HCV⁺/HBV⁺ (20.1%) were HCV viremic (excluded from further analyses), compared to 85 of 251 HCV⁺/HBV^– subjects (33.9%; p <0.05). Mean age of HCV RNA⁺/HBV^– (HCV RNA⁺) subjects was 40 years compared to 36 years for HIV (p <0.0001) and 40% vs 34% were male, respectively (p = 0.11). Median CD4 count (cells/mm³) at baseline was 125 for HCV RNA⁺ vs 136 for HIV, respectively, and at months 3 and 6, CD4 counts increased to 235 vs 237 and 236 vs 252 for HCV RNA⁺ vs HIV subjects, respectively (p >0.05). Median HIV viral load (copies/mL) at baseline was 57,128 for HCV RNA⁺ vs 51,576 for HIV (p = 0.88) and at month 6, 68% of HCV RNA⁺ and 76% of HIV subjects had HIV viral load <400 (p = 0.15). For subjects with baseline and month 6 ALT, median ALT at baseline was:  HCV RNA⁺ ALT = 27.3 vs 19.1 in HIV (p = 0.02) and at month 6, median ALT was significantly higher in HCV RNA⁺ (ALT = 36.6) vs HIV (ALT = 25; p <0.001). For subjects with baseline and either month 3 or month 6 ALT values, there was a 3.1% incidence of hepatotoxicity by month 6 in HCV RNA⁺ compared to 0.7% in HIV (p <0.05). The median age of those with hepatotoxicity was 39 years for HCV RNA⁺ vs 30 years for HIV and 100% of HCV RNA⁺ with hepatotoxicity were female compared to 88% of HIV subjects.

Conclusions:  Surprisingly, only 31.2% of HIV/HCV⁺ subjects had HCV viremia. We found few differences in immune reconstitution or HIV virologic control in this cohort. Incidence of hepatotoxicity was low in both groups during the first 6 months of ART, although significantly higher in subjects with HCV viremia.