Impact of GB virus C viraemia on clinical outcome in HIV-1-infected patients: a 20-year follow-up study

TY - JOUR

T1 - Impact of GB virus C viraemia on clinical outcome in HIV-1-infected patients: a 20-year follow-up study

AU - Ernst, D

AU - Greer, M

AU - Akmatova, R

AU - Pischke, S

AU - Wedemeyer, H

AU - Heiken, H

AU - Tillmann, H L

AU - Schmidt, R E

AU - Stoll, M

N1 - © 2013 British HIV Association.

PY - 2014/4/1

Y1 - 2014/4/1

N2 - OBJECTIVES: The impact of coexisting GB virus C (GBV-C) infection on the clinical course of HIV infection remains controversial. Early data from HIV-1 infected patients attending the Hannover Medical School in 2001 suggested prognostic benefit in GBV-C viraemic patients. The aim of this study was to evaluate patterns in long-term mortality and morbidity outcomes in this cohort. The impact of the introduction of antiretroviral therapy (ART) on the perceived benefits of GBV-C viraemia was subsequently investigated.METHODS: A retrospective follow-up analysis of data in this cohort was performed. GBV-C status (GBV-C RNA positive, antibodies against GBV-C envelope protein E2 or no evidence of GBV-C exposure) had been determined at enrolment, with several markers of HIV disease progression (such as viral load and CD4 cell count) being collated from 1993/1994, 2000 and 2012. These eras were chosen to reflect variations in treatment strategies within the cohort. In addition, mortality and HIV-related morbidity data were collated for all patients.RESULTS: Complete data were available for 156 of 197 patients (79%). In highly active antiretroviral therapy (HAART)-naïve patients, GBV-C RNA positivity conferred significant improvements in the course of HIV infection and mortality as well as lower rates of HIV-related diseases. E2 positivity alone conferred no significant advantage. With the advent of HAART, however, the benefits GBV-C RNA positivity disappeared.CONCLUSIONS: Although GBV-C coinfection appears to inherently improve morbidity and mortality in HIV-infected patients, modern HAART has eradicated these advantages. Evidence of synergy between GBV-C status and HAART response exists, with further studies examining the role of GBV-C in existing treatment de-escalation strategies being required.

AB - OBJECTIVES: The impact of coexisting GB virus C (GBV-C) infection on the clinical course of HIV infection remains controversial. Early data from HIV-1 infected patients attending the Hannover Medical School in 2001 suggested prognostic benefit in GBV-C viraemic patients. The aim of this study was to evaluate patterns in long-term mortality and morbidity outcomes in this cohort. The impact of the introduction of antiretroviral therapy (ART) on the perceived benefits of GBV-C viraemia was subsequently investigated.METHODS: A retrospective follow-up analysis of data in this cohort was performed. GBV-C status (GBV-C RNA positive, antibodies against GBV-C envelope protein E2 or no evidence of GBV-C exposure) had been determined at enrolment, with several markers of HIV disease progression (such as viral load and CD4 cell count) being collated from 1993/1994, 2000 and 2012. These eras were chosen to reflect variations in treatment strategies within the cohort. In addition, mortality and HIV-related morbidity data were collated for all patients.RESULTS: Complete data were available for 156 of 197 patients (79%). In highly active antiretroviral therapy (HAART)-naïve patients, GBV-C RNA positivity conferred significant improvements in the course of HIV infection and mortality as well as lower rates of HIV-related diseases. E2 positivity alone conferred no significant advantage. With the advent of HAART, however, the benefits GBV-C RNA positivity disappeared.CONCLUSIONS: Although GBV-C coinfection appears to inherently improve morbidity and mortality in HIV-infected patients, modern HAART has eradicated these advantages. Evidence of synergy between GBV-C status and HAART response exists, with further studies examining the role of GBV-C in existing treatment de-escalation strategies being required.

KW - Adult

KW - Antiretroviral Therapy, Highly Active

KW - Coinfection

KW - Female

KW - Flaviviridae Infections

KW - Follow-Up Studies

KW - GB virus C

KW - HIV Infections

KW - Humans

KW - Male

KW - Middle Aged

KW - RNA, Viral

KW - Retrospective Studies

KW - Viral Envelope Proteins

KW - Viremia

U2 - 10.1111/hiv.12094

DO - 10.1111/hiv.12094

M3 - SCORING: Journal article

C2 - 24118889

VL - 15

SP - 245

EP - 250

JO - HIV MED

JF - HIV MED

SN - 1464-2662

IS - 4

ER -