Findings published in AIDS Research and Human Retroviruses disprove long-standing belief.

Unlike previously believed, the hepatitis C virus does not slow the immune system’s ability to restore itself after HIV patients are treated with a drug cocktail, according to researchers at Wake Forest University Baptist Medical Center.

Studies to date have found evidence both in support of and against the belief that less than desirable CD4 restoration after highly active antiretroviral therapy (HAART) in co-infected patients is due to the hepatitis C virus, points out Marina Nunez, M.D., lead researcher and an assistant professor of infectious diseases. A limitation in previous research, however, has been that co-infected patients have been identified by the presence of HIV and the hepatitis C antibody. Since many patients with hepatitis C clear the active virus but continue to carry the antibody, there hasn’t been a pure sample of patients truly co-infected with both active viruses.

In this retrospective study, only patients with HIV and active hepatitis C cell replication were classified as co-infected. It looked at whether having HCV co-infection impairs immune restoration in patients receiving HAART to suppress their HIV infection. The scientists focused on levels of CD4 cells and their ability to rebuild after HIV is suppressed.

The researchers examined existing medical records of 322 patients from two databases from Madrid  and Wake Forest University Baptist Medical Center. Patients were separated into two groups: those co-infected with hepatitis C and HIV and those infected only with HIV. Researchers reviewed CD4 levels at baseline before beginning HIV suppression and every year after for up to three years while the patients continuously received HAART.

The study found that there is no difference in the CD4 restoration of co-infected patients and mono-infected patients. However, it did show some differences that seem to be associated with age, gender, or past intravenous drug use.
“From a clinical standpoint, although these findings will not alter the clinical management of HIV-HCV-co-infected patients, they make clear that even after successful treatment of the HCV infection, some patients may still not get an adequate CD4 recovery under HIV treatment.”

The results appear in the July issue of AIDS Research and Human Retroviruses.

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