Effect of hepatitis C infection on progression of HIV disease and early response to initial antiretroviral therapy.

OBJECTIVES: To describe the effect of hepatitis C virus (HCV) on the progression of HIV disease and on early changes in the CD4 cell count and HIV viral load after HAART initiation. DESIGN AND METHODS: Data were from a longitudinal medical records review project conducted in over 100 US medical clinics from 1998 to 2004. We analysed data from HIV-infected patients who received antiretroviral therapy (ART), calculated adjusted hazard ratios describing the hazard of death or progression to an AIDS-defining opportunistic illness (AIDS-OI) associated with prevalent HCV infection, and estimated the change in CD4 cell count and HIV viral load after HAART initiation, stratified by HCV status. RESULTS: A total of 10 481 HIV-infected individuals were followed for a median of 1.9 years; 19% had HCV. HCV infection was not associated with progression to AIDS-OI or death after controlling for important confounding conditions. Factors significantly confounding the risk of both death and diagnosis of an AIDS-OI were alcoholism, drug-induced hepatitis, and the type of ART prescribed. Acute and chronic hepatitis B infection confounded the risk of AIDS-OI diagnosis. During the 12 months after starting HAART, proportional increases in CD4 cell counts did not differ between HCV-infected and HCV-uninfected individuals. Likewise, the short-term change in viral load did not differ. CONCLUSION: In our cohort, HCV did not increase the risk of death or AIDS-OI, and did not affect the early immunological or virological response to initial HAART. Clinicians should evaluate patients with HCV for other, manageable problems, including alcoholism and other viral hepatitis.

Pregnancy and other factors associated with higher CD4+ T-cell counts at HIV diagnosis in Southeast Michigan, 1992-2002.

BACKGROUND: Early diagnosis of HIV infection provides the opportunity for treatment to prevent progression to AIDS and for intervention to prevent further transmission. The impact of routine screening of pregnant women and other factors on the stage of HIV disease at diagnosis were evaluated. METHODS: Data were collected in 1992-2002 from the medical records of persons presenting for HIV-related care at 2 major medical centers in Detroit, Michigan. Patients were included in the analysis if they had a CD4+ T-cell count recorded within 6 months of their first positive HIV test (N = 1858). RESULTS: Half of the patients (49%) had a first CD4+ T-cell count of < 200 cells/mm3 and 19% had an AIDS-defining illness at the time of HIV diagnosis. In the multivariate model, pregnant women were less likely than nonpregnant women to enter care with a CD4+ T-cell count of < 200 cells/mm3 (odds ratio, .24; 95% confidence interval, .14-.41). Even after adjusting for pregnancy, female sex was protective, as was age < 30 years. HIV-transmission risk factors, race, and time period of HIV diagnosis were not significantly associated with first CD4+ T-cell counts of < 200 cells/mm3. CONCLUSION: Routinely offering HIV testing in prenatal care, as required by Michigan law, resulted in earlier diagnoses of HIV in pregnant women, as indicated by their higher CD4+ T-cell counts. Increasing routine HIV testing of all persons seeking medical care may increase the overall proportion of HIV diagnoses that are made early in the disease process.

Factors that complicate the treatment of tuberculosis in HIV-infected patients.

Treatment of tuberculosis (TB) in persons coinfected with HIV has become increasingly complex during the past decade. We describe the factors that complicate anti-TB therapy in a large observational cohort of HIV-infected persons in the United States. Among 367 HIV-infected patients with 372 episodes of culture-confirmed TB, 44.1% had injection drug use as a mode of HIV transmission. Hepatic disease was present at the time of TB diagnosis or during anti-TB therapy for 91 episodes (24.5%). Elevation at least twice the upper limits of normal of aminotransaminases was observed during the first month of anti-TB therapy in 116 (31.2%) of the episodes. The most commonly reported adverse effects occurring during therapy were rash (27.8%), nausea (26.2%), leukopenia or neutropenia (20.2%), diarrhea (19.3%), vomiting (18.5%), and elevated temperature (>101.5 degrees F [38.6 degrees C], 16.9%). Prescription of a rifamycin and a medication known to interact with rifamycins occurred during 270 (72.6%) episodes. Because HIV-infected patients with TB often have underlying complicating conditions, such as hepatic disease, and are treated with medications that may have toxicities and cause drug-drug interactions, we recommend that clinicians pay careful attention to these factors when treating coinfected patients.