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Abstract and Introduction
Abstract
We examined the prevalence of hepatitis C virus (HCV) infection among HIV-positive individuals in the UK, trends in HCV testing and the impact of HCV on HIV treatment outcomes. Trends over time in HCV prevalence were calculated using each patient's most recent HCV status at the end of each calendar year. Logistic regression was used to identify factors associated with having a HCV antibody test, and Cox regression was used to determine whether HCV status was associated with the time to experiencing an immunological response to highly active antiretroviral treatment (HAART), time to virological response and viral rebound. Of the 31 765 HIV-positive individuals seen for care between January 1996 and September 2007, 20 365 (64.1%) individuals were tested for HCV, and 1807 (8.9%) had detectable HCV antibody. The proportion of patients in follow-up ever tested for HCV increased over time, from 782/8505 (9.2%) in 1996 to 14 280/17 872 (79.9%) in 2007. Nine thousand six hundred and sixty-nine individuals started HAART for the first time in or after January 2000, of whom, 396 (4.1%) were HCV positive. Presence of HCV infection did not affect initial virological response, virological rebound or immunological response. The cumulative prevalence of HCV in the UK CHIC Study is 8.9%. Despite UK guidelines, over 20% of HIV-positive individuals have not had their HCV status determined by 2007. HCV infection had no impact on HIV virological outcomes or immunological response to HIV treatment. The long-term impact on morbidity and mortality remain to be determined.
Introduction
Despite the negative impact of hepatitis C virus (HCV) co-infection on mortality and morbidity rates among HIV-infected individuals, detailed information on the prevalence of HCV/HIV co-infection in the UK is lacking. Results from the British HIV Association (BHIVA) co-infection survey in 2003/4 suggested an estimated HCV prevalence of ≤6% in 71% of treatment centres, while 13% reported an estimated prevalence of >10%. Further information on HCV prevalence in HIV-infected individuals has been limited to that provided by single treatment centres.
Though the biological mechanisms are not clear, HIV-1 infection appears to accelerate the progression of HCV liver disease. Compared to individuals with HCV infection alone, those who are co-infected with HIV have higher rates of advanced fibrosis and cirrhosis, resulting in an increased risk of liver-related mortality. Evidence on the impact of HCV infection on HIV-1 progression remains contradictory. In the Swiss HIV Cohort study, impaired CD4 responses following the initiation of highly active antiretroviral treatment (HAART) and a greater risk of AIDS-defining illness or death were described in co-infected individuals. Although this was supported by other studies, the large EuroSIDA cohort study found no effect on HIV disease progression.
Hepatitis C virus co-infection may complicate HIV treatment by increasing the risk of hepatotoxicity, which may result in HIV treatment discontinuation and potential loss of HIV virological control. However, a protective role of HAART has also been described. We are left with conflicting evidence, driven in part by the differences between cohort study participants, individuals selected to enter research trials and the general clinic population. In response to the potential HIV-1 management complications that HCV co-infection may pose, BHIVA published guidelines on the management of HCV/HIV co-infection, recommending routine HCV testing for all HIV-infected individuals at HIV diagnosis. These guidelines were updated in 2005 to include a recommendation for annual HCV screening of all HIV-infected individuals.
In this study, we report the prevalence of HCV/HIV co-infection in the UK Collaborative HIV Cohort (CHIC) Study population and describe trends in HCV testing over time. We have evaluated the clinical impact of HCV co-infection on treatment outcomes in those starting HAART.
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