Barcelona 2013
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| Abstract #295 - Co-infection | ||||
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Session: 8.5: Co-infection (Parallel) on Monday @ 11.00-13.00 in Mirador Chaired by Authors: Presenting Author: Dr Anna Esteve - Agència de Salut Pública de Catalunya-ICO, Spain |
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| Additional Authors: Dr Jordi Casabona, Sra Cristina Sanclemente, Dra Anna Esteve, Dra Victoria Gonzalez, y Grupo HIVITS-TS, | ||||
| Aim: Several studies have explored long‐term T‐lymphocyte responses to ART, but patterns of CD4 gain in HIV/HCV coinfected patients remain unclear. We compare the long‐term response in CD4+ T cells to ART initiation in patients with and without HCV coinfection within the PISCIS HIV Cohort. | ||||
| Method / Issue: The PISCIS Cohort (14 Spanish hospitals) has enrolled 14,675 HIV infected patients from 1998 until 2011. We selected naïve patients who started ART, with at least 1 CD4 count within 6 months of initiation of ART and a known HCV status. Quantitative characteristics were described through the median and interquartile ranges (IQR). Long‐term CD4 increases between patients with and without HIV/HCV coinfection were modeled as a second‐degree polynomial function using linear mixed models adjusted by age, gender, transmission group and CD4 at ART initiation. | ||||
| Results / Comments: Of 14,576 patients, 4,922 met the inclusion criteria (age 36 years, 80% men, 44% homosexual, 31% heterosexual, 19% injection drug users). There was a median of follow‐up of 6 years (IQR 3‐10), 5.6% died and 15% were lost to follow‐up. We identified 1,187 patients with HIV/HCV for whom the median CD4 T‐cells increased from 242 (IQR, 121‐373) to 359 (IQR, 213‐511) at 15 months, and to 478.5 (315‐699) at 36 months. There were 3,735 HIV‐infected patients for whom CD4 count increased from 296 (IQR, 168‐429) to 450 (IQR, 287‐637) at 15 months and to 516 (340‐718) at 36 months. In the multivariable model, HIV monoinfected patients at ART initiation had a mean CD4 count 31.0 cells/μl higher than HIV/HCV patients (p=0.0008), with a yearly average increase of 3.12 cells/μl higher than HIV/HCV (p<0.0001). In the stratified analysis, multivariable models in HIV/HCV patients showed that the yearly average increase in CD4 count is higher (10 cells/μl) for patients with CD4<200 at ART initiation with respect to those with CD4>750 (p<0.0001). In HIV monoinfected patients with CD4<200 and 201<CD4<350 at initiation of ART, the yearly increase was of 30 and 12 cells/μl higher than patients with baseline CD4>750 (p<0.0001). The predicted mean time to reach CD4>500 in HIV‐infected patients with initial CD4<200 was 3 years while HIV/HCV coinfected patients were unable to reach this threshold, even at 6 years. | ||||
| Discussion: In comparison with HIV‐monoinfected patients, HIV/HCV coinfected patients had a lower long‐term average CD4 response to ART and were unable to reach CD4>500 cells/μl after 6 years of follow‐up. | ||||
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