13.2/15 - IMMUNE DEACTIVATION AND APOPTOSIS AFTER STARTING HAART: DELETERIOUS EFFECT OF HIV/HCV COINFECTION

9^TH EUROPEAN AIDS CONFERENCE (EACS)
1^st EACS RESISTANCE & PHARMACOLOGY WORKSHOP

October 25 - 29, 2003 Warsaw, Poland

13.2 Other Hepatitis

13.2/15 - IMMUNE DEACTIVATION AND APOPTOSIS AFTER STARTING HAART: DELETERIOUS EFFECT OF HIV/HCV COINFECTION

Macias J. (1,2), Maldonado R.³, Miñano J.³, Merchante N.¹, Corzo J.E.², Garcia-Garcia A.¹, Vegara S. (1,2), Mira J.A.¹, Gomez-Mateos J.², * Pineda J.A.²

(1) Servicio de Medicina Interna,² Unidad de Enfermedades Infecciosas,³ Unidad de Investigación, Hospital Universitario de Valme, Seville, Spain

Background of Study: : HIV infection leads to immune overactivation that drives an accelerated apoptosis of CD4+ lymphocytes. HCV infection is associated with an impaired CD4+ cell recovery among HIV-infected patients who start HAART. The causes of this altered response to HAART are unknown, but HCV infection could enhance immune activation and lymphocyte apoptosis. In addition, HAART has no effect on HCV infection, indeed it may increase HCV replication transiently.

Objectives: To evaluate the β2-microglobulin (B2M), soluble tumor necrosis α type II receptor (sTNFrII) and soluble Fas receptor (sFas) levels among HIV-infected patients, with and without HCV coinfection, after starting HAART.

Methods: Antiretroviral-naïve patients, without active opportunistic diseases, who showed persistent HIV viremia <50 copies/ml after starting HAART were retrospectively selected. B2M, sTNFrII and sFas levels were measured at baseline, 3 and 9 months in frozen sera. Procalcitonin (PCT) levels were assessed at baseline to exclude subclinical active infections.

Results: Forty-six patients fulfilled the inclusion criteria, 22 of them were coinfected by HCV. The median levels of B2M, sTNFrII, sFas at baseline, 3 and 9 months by HCV status are shown in the table. The median PCT levels were 42 and 41 ng/dl for the HCV- and HCV+ groups, respectively (p=0.9).

	HCV group	Baseline	3 month	9 month	p (Friedman)
B2M (mg/l)	Positive	2.8	2.1*	1.9*	<0.01
	Negative	2.2	1.6	1.4	<0.01
sTNFrII (ng/ml)	Positive	12**	10*	8.9*	<0.01
	Negative	9.3	7.4	6.1	<0.01
sFas (pg/ml)	Positive	925.9	732.9	693.6*	0.08
	Negative	845.3	608.2	476.2	<0.01

p (U-Mann-Whitney): *<0.01; **p=0.04

Conclusions: HIV/HCV-coinfected patients show a worse immune deactivation and higher levels of apoptosis after starting HAART than patients without HCV coinfection.

Presenting Author: Dr. Juan A. Pineda, Unidad de Enfermedades Infecciosas, Ctra de Cádiz, 41014, Seville, Spain, Phone: +34 955015887

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