Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study

被引:680
作者
Greub, G
Ledergerber, B
Battegay, M
Grob, P
Perrin, L
Furrer, H
Burgisser, P
Erb, P
Boggian, K
Piffaretti, JC
Hirschel, B
Janin, P
Francioli, P
Flepp, M
Telenti, A [1 ]
机构
[1] Univ Lausanne Hosp, Div Infect Dis, CH-1011 Lausanne, Switzerland
[2] Univ Zurich Hosp, Div Infect Dis, CH-8091 Zurich, Switzerland
[3] Univ Basel Hosp, Ctr HIV Res, CH-4031 Basel, Switzerland
[4] Univ Zurich Hosp, Div Diagnost Immunol, CH-8091 Zurich, Switzerland
[5] Univ Hosp, Virol Lab, Geneva, Switzerland
[6] Univ Hosp Bern, Div Infect Dis, CH-3010 Bern, Switzerland
[7] Univ Lausanne Hosp, Div Immunol, Lausanne, Switzerland
[8] Univ Basel, Inst Med Microbiol, CH-4003 Basel, Switzerland
[9] Cantonal Hosp, Dept Internal Med, St Gallen, Switzerland
[10] Ist Cantonale Batteriosierol, Lugano, Switzerland
[11] Univ Hosp, Div Infect Dis, Geneva, Switzerland
[12] SHCS Data Ctr, Lausanne, Switzerland
关键词
D O I
10.1016/S0140-6736(00)03232-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background 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. Methods 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. Results 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/muL=0.79 [0.72-0.87]). Interpretation 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.
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页码:1800 / 1805
页数:6
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