12th Annual Conference of the British HIV Association 29 March–1 April 2006, Brighton, UK

THE EFFECT OF HEPATITIS C VIRUS (HCV) ON HIV PROGRESSION IN A LATE SALVAGE POPULATION: RESULTS FROM THE OPTIMA (OPTIONS IN MANAGEMENT WITH ANTIRETROVIRALS) STUDY

HIV Med 2006; 7(Suppl. 1):4 (abstract no. O15)

Fiona Ewings¹, Brian Angus¹, Sheldon Brown², William Cameron³, Mark Holodniy⁴, Tassos Kyriakides⁵, Joel Singer⁶ and Abdel Babiker^1
1 UK MRC HIV CTU, London, UK, ² Bronx VAMC, NY, USA, ³ University of Ottawa, Ottawa, Canada, ⁴ VA Paolo Alto HCS, CA, USA, ⁵ VA Cooperative Studies, West Haven, CT, USA, ⁶ Canadian HIV Trials Network, Vancouver, Canada

AIMS: Studies on the effect of co-infection with HCV on HIV progression have yielded conflicting results. We aimed to investigate this effect in a late salvage population.

METHODS: Using data from OPTIMA, the effect of HCV on survival and progression to a new AIDS event or death was evaluated using Cox models controlling for treatment and baseline CD4.

RESULTS: Of the 311 patients for whom HCV status and follow-up data were available, 72 (23%) were HCV+. The median (range) follow-up time was 21 (0.7, 47) and 23 (0.3, 47) months for HCV+ and HCV) patients respectively. 25% of HCV+ patients died compared to 16% of HCV) patients. Injecting-drug use was reported as a possible mode of HIV transmission by 74% of HCV+ patients compared with only 26% of HCV) patients. There was evidence to suggest that HCV is associated with impaired survival [HR = 1.79, 95% CI (1.01–3.16), P=0.045]. The effect size was similar after adjusting for mode of transmission [HR = 1.70 (0.86–3.36), P=0.13], but after further controlling for (time-dependent) number of ART drugs the effect was much attenuated [HR = 1.37 (0.67, 2.80), P=0.39]. The median (range) time to first switch/stop of on-study ART was 3.8 (0.03, 36) and 6.5 (0.03, 46) months in HCV+ and HCV) patients, respectively. HCV+ patients were no more likely than HCV) patients to experience an AIDS event during follow-up (23% versus 25%). We found no statistically significant effect of HCV on time to a new AIDS event or death [HR = 1.32 (0.84, 2.08), P=0.23].

CONCLUSIONS: Co-infection with HCV appears to increase the risk of mortality, but this effect might be partly explained by a shorter time to switching/stopping ART. One possible reason may be that HCV+ patients are less able to tolerate ART.

2006-03-29
O15

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