Relation Between HIV-1 and Hepatitis C Viral Load in Patients With Hemophilia

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Abstract
Summary:Coinfection with hepatitis C virus (HCV) and HIV-1 is common in patients with hemophilia and in intravenous drug users. Little, however, is known about the relation between HIV-1 and HCV coinfection and the effects on HCV clearance and pathogenesis. We examined data from 207 HIV-1-infected and 126 HIV-1-uninfected patients with hemophilia enrolled in the multicenter Hemophilia Growth and Devel opment Study. Participants were observed during prospective follow-up for approxi mately 7 years with annual measurements of alanine aminotransferase (ALT), CD4+ cells, and HCV and HIV-1 RNA levels. Clearance of HCV was more likely to occur in those uninfected with HIV-1 (14.3 versus 2.5%; odds ratio [OR] 4.79; 95% confi dence 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 follow-up in those HIV-1-infected (p < .001). In the HIV-1-infected participants, baseline CD4+ cells were inversely related to HCV RNA with every 100-cell increase associated with a 0.19 log10 copy/ml decrease in HCV RNA (p = .002), and HIV-1 and HCV RNA levels were directly related (p = .008). Increasing HCV RNA levels were also associated with significantly higher ALT levels regardless of HIV-1 infection status. These results demonstrate that HIV-1/HCV co infection is associated with a reduced likelihood of HCV clearance and that higher levels of HCV RNA are associated with increased hepatic inflammation. Address correspondence and reprint requests to Eric S. Daar, Cedars-Sinai Medical Center, Division of Infectious Diseases, 1 ] 30E, 8700 Beverly Blvd., Los Angeles, CA 90048 U.S.A.; e-mail: [email protected] CSHS.org The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Manuscript received September 1, 2000; accepted February 23, 2001. © 2001 Lippincott Williams & Wilkins, Inc.