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AIDS Res Ther. 2012; 9: 18.
Published online Jun 15, 2012. doi:  10.1186/1742-6405-9-18
PMCID: PMC3409064
Virological effectiveness and CD4+ T-cell increase over early and late courses in HIV infected patients on antiretroviral therapy: focus on HCV and anchor class received
Davide Motta,1 Nigritella Brianese,1 Emanuele Focà,corresponding author1 Paola Nasta,8 Franco Maggiolo,2 Massimiliano Fabbiani,3 Giuliana Cologni,2 Simona Di Giambenedetto,3 Massimo Di Pietro,4 Nicoletta Ladisa,5 Laura Sighinolfi,6 Silvia Costarelli,7 Filippo Castelnuovo,8 and Carlo Torti1,9
1Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
2Department of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy
3Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
4Infectious Diseases Clinic, Santa Maria Annunziata Hospital, Florence, Italy
5Clinic of Infectious Diseases, Policlinico di Bari, Bari, Italy
6Department of Infectious Diseases, S. Anna Hospital, Ferrara, Italy
7Department of Infectious Diseases, Istituti Ospitalieri, Cremona, Italy
8Spedali Civili di Brescia, Brescia, Italy
9Unit of Infectious Diseases, University “Magna Graecia”, Catanzaro, Italy
corresponding authorCorresponding author.
Davide Motta: davide.motta84/at/gmail.com; Nigritella Brianese: nigri_bri/at/libero.it; Emanuele Focà: emanuelefoca/at/gmail.com; Paola Nasta: paola.nasta/at/tin.it; Franco Maggiolo: franco31556/at/hotmail.com; Massimiliano Fabbiani: massifab/at/alice.it; Giuliana Cologni: giuliana.cologni/at/gmail.com; Simona Di Giambenedetto: simona.digiambenedetto/at/rm.unicatt.it; Massimo Di Pietro: massimo.dipietro/at/asf.toscana.it; Nicoletta Ladisa: nladisa/at/hotmail.com; Laura Sighinolfi: l.sighinolfi/at/ospfe.it; Silvia Costarelli: costarelli.s/at/libero.it; Filippo Castelnuovo: filippo.castelnuovo/at/tiscali.it; Carlo Torti: torti.carlo/at/libero.it
Received April 24, 2012; Accepted June 15, 2012.
Abstract
Background
The aim of this study was to explore the effects of HCV co-infection on virological effectiveness and on CD4+ T-cell recovery in patients with an early and sustained virological response after HAART.
Methods
We performed a longitudinal analysis of 3,262 patients from the MASTER cohort, who started HAART from 2000 to 2008. Patients were stratified into 6 groups by HCV status and type of anchor class. The early virological outcome was the achievement of HIV RNA <500 copies/ml 4–8 months after HAART initiation. Time to virological response was also evaluated by Kaplan-Meier analysis. The main outcome measure of early immunological response was the achievement of CD4+ T-cell increase by ≥100/mm3 from baseline to month 4–8 in virological responder patients. Late immunological outcome was absolute variation of CD4+ T-cell count with respect to baseline up to month 24. Multivariable analysis (ANCOVA) investigated predictors for this outcome.
Results
The early virological response was higher in HCV Ab-negative than HCV Ab-positive patients prescribed PI/r (92.2% versus 88%; p = 0.01) or NNRTI (88.5% versus 84.7%; p = 0.06). HCV Ab-positive serostatus was a significant predictor of a delayed virological suppression independently from other variables, including types of anchor class. Reactivity for HCV antibodies was associated with a lower probability of obtaining ≥100/mm3 CD4+ increase within 8 months from HAART initiation in patients treated with PI/r (62.2% among HCV Ab-positive patients versus 70.9% among HCV Ab-negative patients; p = 0.003) and NNRTI (63.7% versus 74.7%; p < 0.001). Regarding late CD4+ increase, positive HCV Ab appeared to impair immune reconstitution in terms of absolute CD4+ T-cell count increase both in patients treated with PI/r (p = 0.013) and in those treated with NNRTI (p = 0.002). This was confirmed at a multivariable analysis up to 12 months of follow-up.
Conclusions
In this large cohort, HCV Ab reactivity was associated with an inferior virological outcome and an independent association between HCV Ab-positivity and smaller CD4+ increase was evident up to 12 months of follow-up. Although the difference in CD4+ T-cell count was modest, a stricter follow-up and optimization of HAART strategy appear to be important in HIV patients co-infected by HCV. Moreover, our data support anti-HCV treatment leading to HCV eradication as a means to facilitate the achievement of the viro-immunological goals of HAART.
Keywords: HIV, HCV, HAART
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