Greub G, Ledergerber B, Battegay M, Grob P, Perrin L, Furrer H, Burgisser P, Erb P, Boggian K, Piffaretti J C, Hirschel B, Janin P, Francioli P, Flepp M, Telenti A
Division of Infectious Diseases, University Hospital, Lausanne, Switzerland.
Lancet. 2000 Nov 25;356(9244):1800-5. doi: 10.1016/s0140-6736(00)03232-3.
Hepatitis C virus (HCV) infection is highly prevalent among HIV-1-infected individuals, but its contribution to the morbidity and mortality of coinfected patients who receive potent antiretroviral therapy is controversial. We used data from the ongoing Swiss HIV Cohort Study to analyse clinical progression of HIV-1, and the virological and immunological response to potent antiretroviral therapy in HIV-1-infected patients with or without concurrent HCV infection.
We analysed prospective data on survival, clinical disease progression, suppression of HIV-1 replication, CD4-cell recovery, and frequency of changes in antiretroviral therapy according to HCV status in 3111 patients starting potent antiretroviral therapy.
1157 patients (37.2%) were coinfected with HCV, 1015 of whom (87.7%) had a history of intravenous drug use. In multivariate Cox's regression, the probability of progression to a new AIDS-defining clinical event or to death was independently associated with HCV seropositivity (hazard ratio 1.7 [95% CI 1.26-2.30]), and with active intravenous drug use (1.38 [1.02-1.88]). Virological response to antiretroviral therapy and the probability of treatment change were not associated with HCV serostatus. In contrast, HCV seropositivity was associated with a smaller CD4-cell recovery (hazard ratio for a CD4-cell count increase of at least 50 cells/microL=0.79 [0.72-0.87]).
HCV and active intravenous drug use could be important factors in the morbidity and mortality among HIV-1-infected patients, possibly through impaired CD4-cell recovery in HCV seropositive patients receiving potent antiretroviral therapy. These findings are relevant for decisions about optimum timing for HCV treatment in the setting of HIV infection.
丙型肝炎病毒（HCV）感染在HIV-1感染者中高度流行，但其对接受高效抗逆转录病毒治疗的合并感染患者的发病率和死亡率的影响存在争议。我们利用正在进行的瑞士HIV队列研究的数据，分析了HIV-1的临床进展，以及合并或未合并HCV感染的HIV-1感染者对高效抗逆转录病毒治疗的病毒学和免疫学反应。
我们分析了3111例开始接受高效抗逆转录病毒治疗的患者的生存、临床疾病进展、HIV-1复制抑制、CD4细胞恢复情况以及根据HCV状态进行的抗逆转录病毒治疗变化频率的前瞻性数据。
1157例患者（37.2%）合并HCV感染，其中1015例（87.7%）有静脉吸毒史。在多变量Cox回归分析中，进展至新的艾滋病定义临床事件或死亡的概率与HCV血清学阳性独立相关（风险比1.7[95%CI 1.26-2.30]），与活跃的静脉吸毒相关（1.38[1.02-1.88]）。对抗逆转录病毒治疗的病毒学反应和治疗改变的概率与HCV血清学状态无关。相比之下，HCV血清学阳性与较小的CD4细胞恢复相关（CD4细胞计数增加至少50个细胞/微升的风险比=0.79[0.72-0.87]）。
HCV和活跃的静脉吸毒可能是HIV-1感染患者发病和死亡的重要因素，可能是通过接受高效抗逆转录病毒治疗的HCV血清学阳性患者的CD4细胞恢复受损。这些发现对于决定HIV感染情况下HCV治疗的最佳时机具有重要意义。
