BACKGROUND & AIMS:
OBJECTIVE:To explore the relationship between hepatitis C virus (HCV)/HIV coinfection and responses to initial antiretroviral treatment (ART).
METHODS:Four AIDS Clinical Trials Group HIV treatment studies' data were combined to compare initial ART responses between HCV/HIV-coinfected and HIV-monoinfected patients as evaluated by virologic failure, CD4 cell measures, occurrence of AIDS/death and grade 3/4 safety events, using Kaplan-Meier estimates and proportional hazard, regression and mixed effects models, adjusting for baseline covariates.
RESULTS:Of the 3041 included participants, 81% were men, 19% had prior history of AIDS, the median (25th, 75th percentile) baseline HIV RNA was 4.72 (4.38-5.18) log10 copies/ml, and the median (25th, 75th percentile) baseline CD4 cell count was 216.0 (76.5-327.0) cells/μl. The 279 HCV/HIV-coinfected individuals were older (44 vs. 37 years), more likely to be black non-Hispanic (47 vs. 36%), and previous/current intravenous drug user (52 vs. 5%) than the 2762 HIV-monoinfected patients (all P values <0.001). HCV/HIV coinfection was associated with earlier virologic failure, hazard ratio (95% confidence interval): 1.43 (1.07-1.91); smaller mean CD4 cell increase and CD4% increase [-33.8 (-52.2 to -15.4) cells/μl and -1.16% (-1.43 to -0.89%), respectively] over a median of 132 weeks of follow-up; earlier occurrence of grade 3/4 safety event, hazard ratio 1.51 (1.26-1.81); and increased AIDS/mortality, hazard ratio 2.10 (1.31-3.37). Treatment effects comparing antiretroviral regimens were not significantly different by HCV/HIV coinfection status.
CONCLUSION:HCV/HIV coinfection is associated with attenuated response to ART. Results support earlier initiation of HIV therapy and increased monitoring of those initiating ART with HCV/HIV coinfection.
背景与目标:
目的:探讨丙型肝炎病毒(HCV)/ HIV合并感染与初始抗逆转录病毒治疗(ART)反应之间的关系。
方法:将四个艾滋病临床试验组的HIV治疗研究数据进行比较,以比较HCV / HIV合并感染和HIV单感染的患者的最初ART反应,并通过病毒学衰竭,CD4细胞测量,AIDS /死亡的发生和3/4级进行评估安全事件,使用Kaplan-Meier估计值和比例风险,回归和混合效应模型,针对基线协变量进行调整。
结果:3041名参与者中,男性占81%,曾有艾滋病史;中位数(第25、75个百分位数)基线HIV RNA为4.72(4.38-5.18)×log10×拷贝/ ml,中位数(第25, 75%的基线CD4细胞计数为216.0(76.5-327.0)细胞/μl。与HCV / HIV合并感染的279名个体相比,年龄更大(44岁对比37岁),更可能是非西班牙裔黑人(47岁对比36%),以及以前/现在的静脉吸毒者(52岁对比5%)。 2762名HIV单一感染患者(所有P值<0.001)。 HCV / HIV合并感染与早期病毒学衰竭,危险比(95%置信区间):1.43(1.07-1.91)相关;在132周的中位数随访中,平均CD4细胞增加和CD4%增加较小[-33.8(-52.2至-15.4)细胞/μl和-1.16%(-1.43至-0.89%)];较早发生3/4级安全事件,危险比1.51(1.26-1.81);艾滋病/死亡率增加,危险比为2.10(1.31-3.37)。比较抗逆转录病毒疗法的治疗效果在HCV / HIV合并感染状态方面无显着差异。
结论:HCV / HIV合并感染与对ART的反应减弱有关。结果支持更早地启动HIV治疗,并加强对以HCV / HIV合并感染启动ART的人群的监测。