DOES HEPATITIS-C VIRUS COINFECTION ACCELERATE CLINICAL AND IMMUNOLOGICAL EVOLUTION OF HIV-INFECTED PATIENTS

Objective: To study the influence of hepatitis C virus (HCV) co-infect ion on clinical and immunological evolution of HIV-infected patients. Design: A longitudinal study of HIV-infected individuals with or witho ut HCV infection, identified at the Infectious Diseases Department of Dijon University Hospital and enrolled in a historical cohort, was per formed. Methods: One hundred and nineteen HIV-infected people co-infec ted with HCV and 119 matched individuals infected with HIV alone were included in the cohort (median participation time 3 years; range, 2 mo nths to 11.5 years). Clinical progression was defined as one or more o f the following: a 30% decrease in the Karnofsky index; a 20% loss of body weight; an AIDS-defining illness (for non-AIDS patients); death ( except by accident, suicide or overdose). Immunological progression wa s defined as a 50% decrease in the initial CD4 T-cell count (for patie nts with an initial count > 100 x 10(6) cells/l). Effects of HCV co-in fection were evaluated using Kaplan-Meier survival analysis and signif icance was tested using univariate (log-rank and Peto's tests) and mul tivariate methods (Cox's model). Results: In univariate analysis, immu nological progression was not statistically different between the HCV- positive group and the HCV-negative group, whereas clinical progressio n was significantly faster in HCV-positive patients (P < 0.005, log-ra nk test). In a multivariate Cox model, clinical progression remained s ignificantly associated with infection by HCV [hazard ratio (HR), 1.64 ; 95% confidence interval (CI), 1.06-2.55; P < 0.05]. Stratified multi variable analysis retained HCV as a significant prognostic factor of c linical progression (HR, 10.9; 95% CI, 1.09-109.3; P < 0.05) and immun ological progression (HR, 2.31; 95% CI, 1.16-4.62; P < 0.02) for patie nts with an initial CD4 count above 600 x 10(6) cells/l. Conclusions: Clinical progression is more rapid in HIV-HCV co-infected patients tha n in HIV-seropositive patients are not infected by HCV. The prognostic value of HCV infection for both clinical and immunological progressio n is significant at early stages of HIV infection. These findings may argue for active management of hepatitis C infection in co-infected in dividuals, especially for asymptomatic patients whose CD4 count is abo ve 600 x 10(6) cells/l, to predict and prevent accelerated progression of HCV and HIV diseases. (C) 1998 Rapid Science Ltd.