Stafford Kristen A, Rikhtegaran Tehrani Zahra, Saadat Saman, Ebadi Maryam, Redfield Robert R, Sajadi Mohammad M
Institute of Human Virology Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD Pasteur Institute of Iran, Tehran Hamadan University of Medical Sciences, Hamedan, Hamadan Province, Iran Department of Medicine, Baltimore VA Medical Center, Baltimore, MD.
Medicine (Baltimore). 2017 Jun;96(26):e7348. doi: 10.1097/MD.0000000000007348.
To estimate the effect of hepatitis C virus (HCV) coinfection on the development of complications and progression of human immunodeficiency virus (HIV) disease among HIV-infected elite controllers.Single-center retrospective cohort. Kaplan-Meier methods, prevalence ratios, and Cox proportional-hazards models were used.In all, 55 HIV-infected elite controllers were included in this study. Among them, 45% were HIV/HCV coinfected and 55% were HIV mono-infected. Median follow-up time for the cohort was 11 years. Twenty-five patients experienced a complication and 16 lost elite controller status during the study period. HCV coinfected patients were 4.78 times (95% confidence interval 1.50-15.28) more likely to develop complications compared with HIV mono-infected patients. There was no association between HCV coinfection status and loss of elite control (hazard ratio 0.75, 95% confidence interval 0.27-2.06).Hepatitis C virus coinfection was significantly associated with the risk of complications even after controlling for sex, injecting drug use, and older age. HCV coinfected patients had higher levels of cellular activation while also having similar levels of lipopolysaccharide and soluble CD14. HCV coinfection was not associated with loss of elite controller status. Taken together, this suggests that HCV coinfection does not directly affect HIV replication dynamics or natural history, but that it may act synergistically with HIV to produce a greater number of associated complications. Continued follow-up will be needed to determine whether HCV cure through the use of direct-acting antivirals among HIV/HCV coinfected elite controllers will make the risk for complications among these patients similar to their HIV mono-infected counterparts.
评估丙型肝炎病毒（HCV）合并感染对HIV感染的精英控制者中并发症发生及人类免疫缺陷病毒（HIV）疾病进展的影响。单中心回顾性队列研究。采用Kaplan-Meier方法、患病率比和Cox比例风险模型。本研究共纳入55名HIV感染的精英控制者。其中，45%为HIV/HCV合并感染，55%为HIV单感染。队列的中位随访时间为11年。25名患者在研究期间出现并发症，16名失去精英控制者状态。与HIV单感染患者相比，HCV合并感染患者发生并发症的可能性高4.78倍（95%置信区间1.50 - 15.28）。HCV合并感染状态与精英控制丧失之间无关联（风险比0.75，95%置信区间0.27 - 2.06）。即使在控制了性别、注射吸毒和年龄等因素后，丙型肝炎病毒合并感染仍与并发症风险显著相关。HCV合并感染患者的细胞活化水平较高，而脂多糖和可溶性CD14水平相似。HCV合并感染与精英控制者状态丧失无关。综上所述，这表明HCV合并感染不会直接影响HIV复制动态或自然病程，但可能与HIV协同作用产生更多相关并发症。需要持续随访以确定在HIV/HCV合并感染的精英控制者中通过使用直接抗病毒药物治愈HCV是否会使这些患者的并发症风险与其HIV单感染的对应者相似。
