Impact of Hepatitis C Virus (HCV) on CD4+ T-Lymphocyte Count < 200 cells/µL among HIV-Positive Adults: A Longitudinal Evaluation

Aims: Previous research on whether Hepatitis C Virus (HCV)/HIV coinfection alters the natural history of HIV disease progression shows conflicting findings. The aim of this study is to investigate whether HCV/HIV coinfection has an adverse effect on the outcome of a CD4+ count < 200 cells/µL in HIV-positive adults.
Study Design: A retrospective longitudinal study.
Place and Duration of Study: Royal University Hospital and West Side Community Clinic in Saskatoon, Canada. Individuals were diagnosed with HIV between January 1, 2005 and September 1, 2011.
Methodology: Data were collected using medical charts. CD4+ count was dichotomized into a binary variable (1 for CD4+ count < 200; 0 for ≥ 200). Independent t-tests or Wilcoxon test, and Chi-square tests were used to compare quantitative and qualitative variables between groups, respectively. The risk factors for CD4+ count < 200 were determined using Generalized Estimating Equations (GEE) marginal logistic regression model. Analysis was done by SAS 9.4 and P<0.05 was considered as statistically significant.
Results: Among 369 patients, 48.5% were female, 72.1% were Aboriginals, 82.4% were HCV/HIV-coinfected and 77.4% had history of Injection Drug Use (IDU) at diagnosis. The mean age at diagnosis was 35.5 years. In univariate GEE logistic regression model, patients with coinfection of HCV/HIV, Aboriginals ethnicity, ever use of Antiretroviral Therapy (ART), social assistance, older age, and higher viral load at baseline were significantly more likely to have CD4+ count < 200. In multivariate model, HCV/HIV coinfection, age, and ART were associated with CD4+ count < 200. Patients with HCV/HIV coinfection, older age, and ever use of ART had significantly higher odds of having CD4+ count < 200 (adjusted odds ratios 2.21, 1.48, and 2.70 respectively).
Conclusions: HCV/HIV-coinfected patients were significantly more likely to have CD4+ count < 200. Results support earlier treatment of HCV and HIV as well as increased monitoring for coinfected individuals.