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Do Sex and HIV/HCV Coinfection Affect Response to Antiretroviral Treatment?

HIV-positive men and women coinfected with hepatitis C virus (HCV) showed impaired CD4 T-cell restoration after starting antiretroviral therapy (ART) and had a 40% greater risk of death than people with HIV alone, though they were equally likely to achieve HIV viral suppression, according to study findings published in the May 18 advance edition of AIDS Patient Care and STDs.

People with HIV tend to experience more rapid HCV-related liver disease progression than HCV-monoinfected patients and historically did not response as well to interferon-based therapy, though their response to the new direct-acting antivirals is just as good. Some research has found that HIV/HCV coinfected people have smaller CD4 cell gains on ART, but study findings have been inconsistent.

Julia Marcus from Kaiser Permanente Northern California and colleagues looked at the effects of sex and HCV coinfection on response to antiretroviral treatment for HIV. Women normally have slightly higher CD4 counts than men, but studies comparing CD4 cell recovery on ART between men and women have also been inconsistent.

This cohort study looked at nearly 13,000 HIV-positive adult members of the Kaiser Permanente California health organization who started ART during 1996-2011. The analysis included 154 HIV/HCV coinfected women, 1000 HIV/HCV coinfected men, 1088 HIV monoinfected women, and 10,623 HIV monoinfected men.

The researchers assessed changes in CD4 count by sex and HCV status over 5 years. They also estimated the likelihood of achieving HIV viral suppression (HIV RNA <500 copies/mL) over 1 year and progression to AIDS and death over the full follow-up period.

Results

• HIV/HCV coinfected women and men experienced significantly smaller CD4 cell increases during the first year on ART than HIV monoinfected women and men (70 and 75 cells/mm³ vs 145 and 120 cells/mm³, respectively).
• After 5 years on ART, women had significantly higher CD4 counts than men, and this was the case for both HIV/HCV coinfected (567 vs 509 cells/mm³) and HIV monoinfected (598 vs 562 cells/mm³) participants.
• Regardless of sex, HIV/HCV coinfection was associated with 40% higher mortality compared with HIV monoinfection.
• However, coinfection was not associated with lower likelihood of achieving HIV RNA <500 copies/mL or with progression to AIDS.

"HIV/HCV co-infected men and women have slower CD4 recovery after starting ART and have increased mortality compared with HIV mono-infected men and women," the study authors concluded.

They recommended that hepatitis C "should be aggressively treated in HIV/HCV co-infected adults, regardless of sex." This is consistent with current treatment guidelines, which prioritize both HIV and hepatitis C treatment for coinfected individuals.

5/28/15

Reference

JL Marcus, WA Leyden, CR Chao, et al. Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status. AIDS Patient Care and STDs. May 18, 2015 (Epub ahead of print).