Barcelona 2013
Barcelona 2013
Abstract book - Abstract - 295
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Conference Details
International Committee
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Presenting Speakers
Scientific Committee
Abstract #295  -  Co-infection
  8.5: Co-infection (Parallel) on Monday @ 11.00-13.00 in Mirador Chaired by
  Presenting Author:   Dr Anna Esteve - Agència de Salut Pública de Catalunya-ICO, Spain
  Additional Authors:  Dr Jordi  Casabona, Sra Cristina Sanclemente, Dra Anna Esteve, Dra Victoria Gonzalez, y Grupo HIVITS-TS,  
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&#8208;up of 6 years (IQR 3&#8208;10), 5.6% died and 15% were lost to follow&#8208;up. We identified 1,187 patients with HIV/HCV for whom the median CD4 T&#8208;cells increased from 242 (IQR, 121&#8208;373) to 359 (IQR, 213&#8208;511) at 15 months, and to 478.5 (315&#8208;699) at 36 months. There were 3,735 HIV&#8208;infected patients for whom CD4 count increased from 296 (IQR, 168&#8208;429) to 450 (IQR, 287&#8208;637) at 15 months and to 516 (340&#8208;718) at 36 months. In the multivariable model, HIV monoinfected patients at ART initiation had a mean CD4 count 31.0 cells/&#956;l higher than HIV/HCV patients (p=0.0008), with a yearly average increase of 3.12 cells/&#956;l 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/&#956;l) 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/&#956;l higher than patients with baseline CD4>750 (p<0.0001). The predicted mean time to reach CD4>500 in HIV&#8208;infected patients with initial CD4<200 was 3 years while HIV/HCV coinfected patients were unable to reach this threshold, even at 6 years.
In comparison with HIV&#8208;monoinfected patients, HIV/HCV coinfected patients had a lower long&#8208;term average CD4 response to ART and were unable to reach CD4>500 cells/&#956;l after 6 years of follow&#8208;up.
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