Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects

Andrea De Luca, Roberto Bugarini, Alessandro Cozzi Lepri, Massimo Puoti, Enrico Girardi, Andrea Antinori, Antonio Poggio, Gabriella Pagano, Giulia Tositti, Gianpiero Cadeo, Antonio Macor, Mario Toti, Antonella D Arminio Monforte

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Abstract

Background: The effect of chronic coinfection with hepatitis viruses on the response to therapy against human immunodeficiency virus 1 (HIV-1) remains debated. Methods: In a prospective cohort study, the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) serostatus on the outcome of potent HIV-1 therapy was analyzed in HIV-1-infected patients previously naive to antiretroviral therapy. Changes from baseline CD4 + cell counts and HIV RNA levels over time were analyzed by linear regression models. Time to clinical progression and time to reach virologic and immunologic response were analyzed by multivariate Cox proportional hazards regression models. Results: We studied 1320 patients, among whom 600 were HCV antibody-positive and 90 were HBV surface antigen-positive. During a median follow-up of 37 months (range, 1-48 months), clinical progression was observed in 99 patients (56 new acquired immunodeficiency syndrome-defining events and 43 deaths). In multivariate models, HCV-positive HBV-negative patients showed a shorter time to clinical progression (hazard ratio, 1.55; 95% confidence interval, 1.00-2.41). Patients who were HCV-positive also showed mean CD4 + recoveries over time that were at least 30 cells/μL fewer than those of seronegative patients. Hepatitis virus serostatus did not affect the virologic response to HIV-1 therapy. Conclusions: Clinical progression of HIV-1 disease after starting potent antiretroviral therapy is accelerated by concomitant infection with HCV. Compared with patients without coinfection, coinfected patients showed impaired CD4 + cell recovery, despite similar virologic response to HIV-1 therapy. These findings may have important implications for the treatment of HCV and for the timing of initiation of HIV-1 therapy in coinfected individuals.

Original languageEnglish
Pages (from-to)2125-2132
Number of pages8
JournalArchives of Internal Medicine
Volume162
Issue number18
DOIs
Publication statusPublished - Oct 14 2002

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Hepatitis Viruses
Coinfection
HIV-1
HIV
Hepacivirus
Hepatitis B virus
Therapeutics
Linear Models
Cohort Effect
Hepatitis C Antibodies
Virus Diseases
CD4 Lymphocyte Count
Hepatitis B Surface Antigens
Proportional Hazards Models
Acquired Immunodeficiency Syndrome
Cohort Studies
Prospective Studies
RNA
Confidence Intervals
Infection

ASJC Scopus subject areas

  • Internal Medicine

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Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects. / De Luca, Andrea; Bugarini, Roberto; Lepri, Alessandro Cozzi; Puoti, Massimo; Girardi, Enrico; Antinori, Andrea; Poggio, Antonio; Pagano, Gabriella; Tositti, Giulia; Cadeo, Gianpiero; Macor, Antonio; Toti, Mario; Monforte, Antonella D Arminio.

In: Archives of Internal Medicine, Vol. 162, No. 18, 14.10.2002, p. 2125-2132.

Research output: Contribution to journalArticle

De Luca, A, Bugarini, R, Lepri, AC, Puoti, M, Girardi, E, Antinori, A, Poggio, A, Pagano, G, Tositti, G, Cadeo, G, Macor, A, Toti, M & Monforte, ADA 2002, 'Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects', Archives of Internal Medicine, vol. 162, no. 18, pp. 2125-2132. https://doi.org/10.1001/archinte.162.18.2125
De Luca, Andrea ; Bugarini, Roberto ; Lepri, Alessandro Cozzi ; Puoti, Massimo ; Girardi, Enrico ; Antinori, Andrea ; Poggio, Antonio ; Pagano, Gabriella ; Tositti, Giulia ; Cadeo, Gianpiero ; Macor, Antonio ; Toti, Mario ; Monforte, Antonella D Arminio. / Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects. In: Archives of Internal Medicine. 2002 ; Vol. 162, No. 18. pp. 2125-2132.
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abstract = "Background: The effect of chronic coinfection with hepatitis viruses on the response to therapy against human immunodeficiency virus 1 (HIV-1) remains debated. Methods: In a prospective cohort study, the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) serostatus on the outcome of potent HIV-1 therapy was analyzed in HIV-1-infected patients previously naive to antiretroviral therapy. Changes from baseline CD4 + cell counts and HIV RNA levels over time were analyzed by linear regression models. Time to clinical progression and time to reach virologic and immunologic response were analyzed by multivariate Cox proportional hazards regression models. Results: We studied 1320 patients, among whom 600 were HCV antibody-positive and 90 were HBV surface antigen-positive. During a median follow-up of 37 months (range, 1-48 months), clinical progression was observed in 99 patients (56 new acquired immunodeficiency syndrome-defining events and 43 deaths). In multivariate models, HCV-positive HBV-negative patients showed a shorter time to clinical progression (hazard ratio, 1.55; 95{\%} confidence interval, 1.00-2.41). Patients who were HCV-positive also showed mean CD4 + recoveries over time that were at least 30 cells/μL fewer than those of seronegative patients. Hepatitis virus serostatus did not affect the virologic response to HIV-1 therapy. Conclusions: Clinical progression of HIV-1 disease after starting potent antiretroviral therapy is accelerated by concomitant infection with HCV. Compared with patients without coinfection, coinfected patients showed impaired CD4 + cell recovery, despite similar virologic response to HIV-1 therapy. These findings may have important implications for the treatment of HCV and for the timing of initiation of HIV-1 therapy in coinfected individuals.",
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T1 - Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects

AU - De Luca, Andrea

AU - Bugarini, Roberto

AU - Lepri, Alessandro Cozzi

AU - Puoti, Massimo

AU - Girardi, Enrico

AU - Antinori, Andrea

AU - Poggio, Antonio

AU - Pagano, Gabriella

AU - Tositti, Giulia

AU - Cadeo, Gianpiero

AU - Macor, Antonio

AU - Toti, Mario

AU - Monforte, Antonella D Arminio

PY - 2002/10/14

Y1 - 2002/10/14

N2 - Background: The effect of chronic coinfection with hepatitis viruses on the response to therapy against human immunodeficiency virus 1 (HIV-1) remains debated. Methods: In a prospective cohort study, the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) serostatus on the outcome of potent HIV-1 therapy was analyzed in HIV-1-infected patients previously naive to antiretroviral therapy. Changes from baseline CD4 + cell counts and HIV RNA levels over time were analyzed by linear regression models. Time to clinical progression and time to reach virologic and immunologic response were analyzed by multivariate Cox proportional hazards regression models. Results: We studied 1320 patients, among whom 600 were HCV antibody-positive and 90 were HBV surface antigen-positive. During a median follow-up of 37 months (range, 1-48 months), clinical progression was observed in 99 patients (56 new acquired immunodeficiency syndrome-defining events and 43 deaths). In multivariate models, HCV-positive HBV-negative patients showed a shorter time to clinical progression (hazard ratio, 1.55; 95% confidence interval, 1.00-2.41). Patients who were HCV-positive also showed mean CD4 + recoveries over time that were at least 30 cells/μL fewer than those of seronegative patients. Hepatitis virus serostatus did not affect the virologic response to HIV-1 therapy. Conclusions: Clinical progression of HIV-1 disease after starting potent antiretroviral therapy is accelerated by concomitant infection with HCV. Compared with patients without coinfection, coinfected patients showed impaired CD4 + cell recovery, despite similar virologic response to HIV-1 therapy. These findings may have important implications for the treatment of HCV and for the timing of initiation of HIV-1 therapy in coinfected individuals.

AB - Background: The effect of chronic coinfection with hepatitis viruses on the response to therapy against human immunodeficiency virus 1 (HIV-1) remains debated. Methods: In a prospective cohort study, the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) serostatus on the outcome of potent HIV-1 therapy was analyzed in HIV-1-infected patients previously naive to antiretroviral therapy. Changes from baseline CD4 + cell counts and HIV RNA levels over time were analyzed by linear regression models. Time to clinical progression and time to reach virologic and immunologic response were analyzed by multivariate Cox proportional hazards regression models. Results: We studied 1320 patients, among whom 600 were HCV antibody-positive and 90 were HBV surface antigen-positive. During a median follow-up of 37 months (range, 1-48 months), clinical progression was observed in 99 patients (56 new acquired immunodeficiency syndrome-defining events and 43 deaths). In multivariate models, HCV-positive HBV-negative patients showed a shorter time to clinical progression (hazard ratio, 1.55; 95% confidence interval, 1.00-2.41). Patients who were HCV-positive also showed mean CD4 + recoveries over time that were at least 30 cells/μL fewer than those of seronegative patients. Hepatitis virus serostatus did not affect the virologic response to HIV-1 therapy. Conclusions: Clinical progression of HIV-1 disease after starting potent antiretroviral therapy is accelerated by concomitant infection with HCV. Compared with patients without coinfection, coinfected patients showed impaired CD4 + cell recovery, despite similar virologic response to HIV-1 therapy. These findings may have important implications for the treatment of HCV and for the timing of initiation of HIV-1 therapy in coinfected individuals.

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