Relation between HIV-1 and hepatitis C viral load in patients with hemophilia

Coinfection with hepatitis C virus (HCV) and HIV-1 is common in patients wi th hemophilia and in intravenous drug users. Little, however, is known abou t the relation between HIV-1 and HCV coinfection and the effects on HCV cle arance and pathogenesis. We examined data from 207 HIV-1-infected and 126 H IV-1-uninfected patients with hemophilia enrolled in the multicenter Hemoph ilia Growth and Development Study. Participants were observed during prospe ctive follow-up for approximately 7 years with annual measurements of alani ne aminotransferase (ALT), CD4(+) cells, and HCV and HIV-1 RNA levels. Clea rance of HCV was more likely to occur in those uninfected with HIV-1 (14.3 versus 2.5%; odds ratio [OR] 4.79: 95% confidence interval [CI], 1.63-14.08 . p = .005) and was more common with decreasing age (OR, 1.23; 95% CI, 1.04 -1.47; p = .017). HCV RNA levels were higher throughout the 7 years of foll ow-up in those HIV-1-infected (p < .001). In the HIV-1-infected participant s, baseline CD4(+) cells were inversely related to HCV RNA with every 100-c ell increase associated with a 0.19 log(10) copy/ml decrease in HCV RNA (p = .002), and HIV-1 and HCV RNA levels were directly related (p = .008). Inc reasing HCV RNA levels were also associated with significantly higher ALT l evels regardless of HIV-1 infection status. These results demonstrate that HIV-1/HCV coinfection is associated with a reduced likelihood of HCV cleara nce and that higher levels of HCV RNA are associated with increased hepatic inflammation.