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Slower Disease Progression and Greater CD4 Response to Antiretroviral Treatment in HIV Patients Co-infected with GBV-C
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Although most studies so far have consistently reported higher CD4 cell counts and lower HIV RNA in untreated HIV-infected patients (pts) co-infected with GBV-C, whether and how GBV-C impacts on HIV disease progression (DP) remains uncertain. To control for Antiretroviral Treatment (ART) received, we studied GBV-C co-infection in a 3-yr randomized trial with clinical end-points.
A group of 326 untreated patients randomized to AZT alone or in combination with DDI or DDC was sampled from Delta (1992-1995). The
presence of GBV-C was determined at baseline (BL) by 2 rounds of RT-PCR on RNA extracted from serum. CD4, HIV RNA and clinical events were recorded every 2-4 months. GBV-C positive and negative patients were compared both at BL and longitudinally using Cox models including BL variables either alone or combined to the CD4 response.
The patient group population was similar to the whole Delta trial population in respect to BL characteristics. Ninety-seven (97) out of 326 (29.8%) were GBV-C RNA positive. Prevalence was similar across risk groups. GBV-C positive patients were younger (mean: 34 vs 37 yrs) had significantly higher CD4
cell counts (252 vs 224) and lower HIV RNA (4.56 vs 4.72) than negative patients.
GBV-C positive and negative patients were equally distributed across the 3
treatment arms. During a 29 months median follow-up, 79 patients progressed either to AIDS (n = 40) or death (n = 39). Adjusted on BL CD4, BL HIV RNA and sex, disease progression was slower (OR = 0.45) in GBV-C positive compared to negative patients. Reduction in HIV RNA was identical in GBV-C positive and negative patientts.
In contrast, increase in CD4 cell count was greater in positive than in negative patients in particular at W64 (p = 0.05), and W80 (p = 0.04) with a trend toward slower return to BL value (p = 0.07). When adjusted on CD4 response, in addition to BL characteristics, disease progression was no longer significantly different in positive and negative patients.
Authors concluded that in this cohort, GBV-C co-infected patients had a better CD4 response to ART than GBV-C negative patients which explained in part their slower progression to AIDS or death. Immunologic implications of GBV-C co-infection in HIV should be further investigated.
Abst 849. Retrovirus Conference 2003, Feb 10-14J. P. Aboulker et al. INSERM SC10, Villejuif, France and Hosp Bichat-Claude Bernard, Paris, France
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