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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Clinical Progression, Survival, and Immune Recovery During Antiretroviral Therapy in Patients with HIV-1 and Hepatitis C Virus Coinfection: The Swiss HIV Cohort Study [Greub G, et al. Lancet 2000; 356;1800]: This is a report from the Swiss HIV Cohort Study to determine the effect of HCV on HIV infection. The Swiss Cohort includes 3,111 patients given HAART, including 1,015 with positive HCV serology. Among those with HCV, 88% had a history of injection drug use; of the 1,954 who were HCV seronegative, only 5% had injection drug use as a risk factor for HIV. The median follow-up period was 28 months. Death was ascribed to end-stage liver disease in 6 of the 1,157 with HCV-positive serology (0.5%). Patients with positive HCV serology had higher rates of AIDS-defining opportunistic infections (7.5% versus 4.7%; p = 0.001) and a smaller number with a CD4 cell count increase of at least 50/mm3 (75% versus 84%; OR = 0.8). The authors conclude that HCV coinfection appears to increase morbidity and mortality and that the impaired CD4 cell recovery may represent an indication for anti-HCV therapy.
Comment: There is a prevalent impression that end-stage liver disease ascribed to HCV is relatively common in co-infected patients. In this study the mortality rate ascribed to liver failure was only 0.5%. Others have reported similar low rates [BMJ 1990;301:1362]. There are multiple studies of HCV/HIV coinfection, and most show no difference in the rate of HIV-related complications [CID 1993;17:117; Am J Med 1999;107:79S; AIDS 1998;12:381]. Many studies show this coinfection has major consequences in terms of the rate of progressive liver disease due to HCV [JID 1999;179:1254]. The Swiss Cohort Study appears to be the first to demonstrate an increase in the rate of opportunistic infections ascribed to HIV and a blunted CD4 cell response to HAART among those with HCV coinfection compared to those with HIV alone. Nevertheless, the difference is not great and appears to be statistically significant primarily because of the large sample size of over 1,000 patients. In an editorial published one week later, C. Graham and M. J. Koziel from the BI Deaconess Medical Center [Lancet 2000;356:1865] point out that co-infected patients may benefit from therapy directed against HCV to reduce the frequency of HCV-related liver disease and also to increase effectiveness of HAART.
posted 1/4/2001





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