From Cedars-Sinai Medical Center
High blood levels of Hepatitis C in patients co-infected with the Human Immunodeficiency Virus (HIV) may increase the risk of developing AIDS
Los Angeles (February 21, 2001) – Researchers at Cedars-Sinai Medical Center report that high amounts of Hepatitis C (HCV) in the blood and simultaneous co-infection with the human immunodeficiency virus (HIV) may be linked to a greater risk of developing AIDS and AIDS related death. Their findings are reported in the February 15 issue of the Journal of Infectious Diseases.
"Our study shows that higher blood levels of HCV may have a detrimental effect on HIV progression to full-blown AIDS," said Eric Daar, M.D., Director of Infectious Diseases and AIDS at the Cedars-Sinai Center for Immune Disorders. "Our findings may have implications for how best to treat HCV in patients co-infected with HIV."
Although HIV is the virus that causes AIDS, HCV is a virus that causes severe damage to the liver. Both viruses are transmitted primarily through blood-to-blood and sexual contact, injecting drug users (who share needles) and through infected women who pass HIV or HCV to their baby during pregnancy or delivery. However, most new cases of HCV are due to high-risk drug behaviors, with about 36,000 Americans newly infected each year. Similarly, the majority of the 128,289 new cases of HIV infections reported last year were due to high-risk drug and sexual behaviors.
"Taken together, this means that a large number of patients with HIV, are also infected with Hepatitis C," said Dr. Daar. "And, given the results of our study, we recommend that patients diagnosed with HIV be tested for HCV."
Because patients with HIV are often co-infected with HCV, the researchers wanted to determine whether HCV played a role in HIV progression to AIDS. Previous studies had already shown that HCV patients infected with HIV developed liver disease sooner than those who were not infected with HIV. Further, a number of smaller studies had shown conflicting results as to whether HCV played a role in HIV progression, with some showing a relationship and others failing to show an association.
To examine the interaction between HCV and HIV disease progression, the investigators examined data collected from 207 hemophiliac patients that were enrolled at multiple centers in the United States and simultaneously co-infected with HCV and HIV. The patients were evaluated over a seven-year period, with CD4+ counts (infection fighting cells), HIV and HCV blood levels measured on an annual basis. Among the 207 patients evaluated, eight had to be excluded because they failed to meet the standard for chronic HCV infection. Of the 194 HIV/HCV co-infected patients remaining, 51 (31 percent) progressed to AIDS and 67 (35 percent) died from the disease.
To determine whether HCV was linked to the development of AIDS and/or AIDS related death, the researchers evaluated CD4+ counts and the independent effects of HIV and HCV on progression to AIDS. They found that patients with higher than average blood levels of HCV were at a greater risk for progression to AIDS or AIDS-related death, as compared to those who had lower than average HCV blood levels.
"Looking at all factors independently, we found that higher levels of HCV were associated with a higher risk for developing AIDS -- even when HIV blood levels were low," said Dr. Daar.
Although the risk of developing AIDS was greater in those patients with high blood levels of both HCV and HIV, the investigators found that high levels of both viruses were associated with a greater risk of AIDS related death.
The way in which higher HCV blood levels may increase the risk of HIV progression to AIDS is not yet known. Some studies have shown that the molecular type of HCV may play a role, while others indicate that higher rates of HCV replication may lead to the development of AIDS.
"More research needs to be done to determine not only how HCV is involved in HIV progression, but whether HIV and HCV specific therapies would benefit co-infected patients," said Dr. Daar.
Cedars-Sinai Medical Center is one of the largest and finest non-profit hospitals in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California’s gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough biomedical research and superlative medical education. The Medical Center ranks among the top seven non-university hospitals in the nation for its research activities.
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