Impact of Hepatitis C Virus (HCV) on CD4+ T-Lymphocyte Count < 200 cells/µL among HIV-Positive Adults: A Longitudinal Evaluation
Prosanta K. Mondal
Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada.
Stephanie Konrad
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.
Michael Schwandt
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.
Stuart Skinner
Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Hyun Ja Lim *
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.
*Author to whom correspondence should be addressed.
Abstract
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.
Keywords: HIV, AIDS, CD4 count, ART, HCV, IDU, GEE, Aboriginals