Effect of HCV in HIV-Infected Patients Initiating HAART
Effect of HCV in HIV-Infected Patients Initiating HAART
Co-infection of human immunodeficiency virus (HIV) with hepatitis C virus (HCV) is rather common. In the era of highly active antiretroviral therapy (HAART), viral hepatitis could result in adverse outcomes in HIV+ patients. The current meta-analysis aims to evaluate the impact of HCV on immunological and virological responses after HAART initiation in HIV/HCV co-infected individuals by synthesizing the existing scientific evidence. A comprehensive search of electronic databases was performed. Eligible studies were analysed using univariate and multivariate meta-analytic methods. Totally, 21 studies involving 22533 individuals were eligible. The estimated summary difference in CD4 cell counts increase between HIV and HIV/HCV co-infected subjects after 3–12 months on HAART was 34.86 cells/mm [95% confidence interval (CI): 16.82–52.89]. The difference was more prominent in patients with baseline CD4 counts below 350 cells/mm (38.97, 95% CI: 20.00–57.93) and attenuated 2 years later (13.43, 95% CI: 0.83–26.04). The analysis of ratio measures yielded similar findings. The virological control remained unaffected by the presence of HCV (adjusted Hazard Ratio for co-infected patients vs those with HIV alone: 0.99, 95% CI: 0.91–1.07). The bivariate meta-analytic method confirmed the results of the univariate approaches. This meta-analysis supports the adverse effect of HCV on immune recovery of HIV+ patients initiating HAART, especially of those with initially impaired immunologic status. Although this effect diminishes over time, early administration of HAART in the setting of co-infection seems to be justified.
The introduction of highly active antiretroviral therapy (HAART) led to an impressive decrease in morbidity and mortality of people infected by human immunodeficiency virus (HIV), but their prolonged survival allowed the emergence of co-morbidities, including infection with hepatitis C virus (HCV).
Double infection by HIV and HCV is common due to similar modes of transmission. Globally, nearly, 20 per cent of individuals with HIV have chronic hepatitis C. Among HIV+ injecting drug users (IDUs), the prevalence of HCV infection ranges between 82 and 93 per cent. HCV incidence has also increased in HIV+ male homosexuals during the last decade.
Primary studies assessing the impact of HCV on HIV disease progression have yielded conflicting results. A recent meta-analysis showed that HIV/HCV co-infection did not affect the incidence of acquired immune deficiency syndrome (AIDS) but increased overall mortality in the HAART era. In terms of early HAART effectiveness, a quantitative synthesis in 2005 showed a less robust immune reconstitution in co-infected patients who initiated antiretroviral treatment.
In the meantime, more relevant studies have been undertaken. The new pieces of information and the lack of a summary appraisal of virological response to HAART in the HIV/HCV setting warranted the conduct of an updated systematic review. The aim of the current meta-analysis was to combine and evaluate the accumulated scientific evidence concerning the effect of HCV on immunological and virological response in HIV-infected patients receiving HAART or combined antiretroviral treatment (c-ART) including at least 3 drugs.
Abstract and Introduction
Abstract
Co-infection of human immunodeficiency virus (HIV) with hepatitis C virus (HCV) is rather common. In the era of highly active antiretroviral therapy (HAART), viral hepatitis could result in adverse outcomes in HIV+ patients. The current meta-analysis aims to evaluate the impact of HCV on immunological and virological responses after HAART initiation in HIV/HCV co-infected individuals by synthesizing the existing scientific evidence. A comprehensive search of electronic databases was performed. Eligible studies were analysed using univariate and multivariate meta-analytic methods. Totally, 21 studies involving 22533 individuals were eligible. The estimated summary difference in CD4 cell counts increase between HIV and HIV/HCV co-infected subjects after 3–12 months on HAART was 34.86 cells/mm [95% confidence interval (CI): 16.82–52.89]. The difference was more prominent in patients with baseline CD4 counts below 350 cells/mm (38.97, 95% CI: 20.00–57.93) and attenuated 2 years later (13.43, 95% CI: 0.83–26.04). The analysis of ratio measures yielded similar findings. The virological control remained unaffected by the presence of HCV (adjusted Hazard Ratio for co-infected patients vs those with HIV alone: 0.99, 95% CI: 0.91–1.07). The bivariate meta-analytic method confirmed the results of the univariate approaches. This meta-analysis supports the adverse effect of HCV on immune recovery of HIV+ patients initiating HAART, especially of those with initially impaired immunologic status. Although this effect diminishes over time, early administration of HAART in the setting of co-infection seems to be justified.
Introduction
The introduction of highly active antiretroviral therapy (HAART) led to an impressive decrease in morbidity and mortality of people infected by human immunodeficiency virus (HIV), but their prolonged survival allowed the emergence of co-morbidities, including infection with hepatitis C virus (HCV).
Double infection by HIV and HCV is common due to similar modes of transmission. Globally, nearly, 20 per cent of individuals with HIV have chronic hepatitis C. Among HIV+ injecting drug users (IDUs), the prevalence of HCV infection ranges between 82 and 93 per cent. HCV incidence has also increased in HIV+ male homosexuals during the last decade.
Primary studies assessing the impact of HCV on HIV disease progression have yielded conflicting results. A recent meta-analysis showed that HIV/HCV co-infection did not affect the incidence of acquired immune deficiency syndrome (AIDS) but increased overall mortality in the HAART era. In terms of early HAART effectiveness, a quantitative synthesis in 2005 showed a less robust immune reconstitution in co-infected patients who initiated antiretroviral treatment.
In the meantime, more relevant studies have been undertaken. The new pieces of information and the lack of a summary appraisal of virological response to HAART in the HIV/HCV setting warranted the conduct of an updated systematic review. The aim of the current meta-analysis was to combine and evaluate the accumulated scientific evidence concerning the effect of HCV on immunological and virological response in HIV-infected patients receiving HAART or combined antiretroviral treatment (c-ART) including at least 3 drugs.
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