Hepatitis C virus coinfection does not lead to faster HIV disease progression in US women's study

HIV-positive women coinfected with hepatitis C virus do not experience faster HIV disease progression, according to a US study published in the March 15^th edition of Clinical Infectious Diseases.

The impact of hepatitis C coinfection on the course of HIV infection is controversial. Although some studies have suggested that coinfection with hepatitis C virus hastens damage to the immune system and the speed of progression to AIDS and death, this has not been the finding of all studies.

Investigators from the US Women and Infants Transmission Study (WITS) wished to address some of the outstanding questions regarding hepatitis C virus coinfection and the speed of HIV disease progression. Investigators prospectively examined the relationship between hepatitis C virus coinfection and CD4 cell percentage, HIV viral load, and progression to AIDS or death from any course. The investigators believed that they were well placed to answer such questions given that they had detailed information on the use of antiretroviral therapy and HAART, and data on illicit drug use, allowing them to adjust for any confounding variables that may result from HAART-related side-effects and hepatitis C virus coinfection.

A total of 652 pregnant women were enrolled to the WITS in several large US cities between 1989 and 1995 and provided a total of 1761 person-years of follow-up. Follow-up was provided until the end of 2003. Hepatitis C virus coinfection was present in 29% of women on enrollment. The mean age at enrollment was 27 years, 42% reported the use of hard drugs during pregnancy, the mean CD4 cell percentage at the study visit closest to delivery was 31% at which time the mean viral load was 63,000 copies/ml.

At the time of delivery hepatitis C virus coinfected women had comparable CD4 cell percentages and viral loads to women who were only infected with HIV. However, the women with hepatitis C virus were significantly older at the time of delivery (29 years versus 26 years, p

HAART was used by a total of 19% of the study population including 13% of women coinfected with hepatitis C virus and 21% of women who were only infected with HIV.

In multivariate analysis, hepatitis C virus coinfected women had a CD4 cell percentage an average of 1.9% higher than women infected with HIV (p

A total of 48 women progressed to AIDS, 17 of whom subsequently died of an AIDS-related cause. In addition, 26 women died without an AIDS-related cause being attributed. In multivariate analysis, hepatitis C virus coinfected patients did not progress faster to AIDS or death.

The investigators acknowledge that a limitation of their study was that the duration of HIV infection in the women was unknown. In addition, the investigators did not have data on hepatitis C viral load or genotype allowing the stratification of their results by these variables.

“In this large cohort of HIV-infected women, we found no evidence that hepatitis C virus coinfection hastens progression of HIV disease” write the investigators. They add “hepatitis C virus infection was not associated with CD4 cell percentage trajectories, HIV RNA level trajectories, or progression to AIDS or death during follow-up.” They conclude “additional research is needed to understand the complex interactions between hepatitis C virus infection and antiretroviral therapy use and effectiveness in many settings worldwide.”