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EACS 2011: Predictors of HCV Viral Load in HIV/HCV Coinfected Patients


Hepatitis C virus (HCV) RNA levels rise over time in HIV/HCV coinfected people, reducing the chances of sustained response to interferon-based treatment. But antiretroviral therapy may help control HCV viral load and contribute to higher likelihood of treatment success, according to a report presented at the 13th European AIDS Conference (EACS 2011) this month in Belgrade.

HIV/HCV coinfected individuals tend to experience more rapid liver disease progression than those with hepatitis C alone. They also respond less well to interferon-based therapy, in part due to higher HCV RNA levels. Prior research indicates that HCV viral load remains relatively stable in HCV monoinfected people, but trends in coinfected people are not well understood.

Daniel Grint and fellow investigators with the EuroSIDA study looked at changes in HCV RNA levels over time and predictors of high HCV viral load among coinfected participants in this large cohort of people with HIV.

EuroSIDA includes more than 16,000 people in 33 European countries, Israel, and Argentina. Within this cohort, 4564 tested positive for HCV antibodies and 1287 had positive HCV RNA, indicating chronic infection.

A majority (70%) of coinfected participants were men and most (about 90%) were white. About three-quarters (74%) had a history of injection drug use and 8% were men who have sex with men (MSM). Just over half had hard-to-treat HCV genotype 1, 30% had genotype 3, 14% had genotype 4, and only 3% had easier-to-treat genotype 2. About 6% were triple infected with hepatitis B virus (HBV), but about 14% had not been tested.

At baseline the median HCV RNA level was 5.87 IU/mL. Participants were followed for a median of 4 years and had a median of 2 HCV viral load tests during that time (range 1 to 10); 250 had at least 3 HCV RNA measurements.


  • In a multivariate model, time had a significant effect on HCV viral load for all genotypes.
  • HCV RNA increased by 5.7% per year overall, and by 6.6% in the subgroup with 3 or more measurements.
  • People with HCV genotype 1 had a 38% higher median HCV RNA level than those with genotypes 3 or 4; genotype 2 fell in between.
  • People with a history of injection drug use had about 34% higher HCV viral load than those in the heterosexual risk group and 44% higher than those in the "other" (i.e., not IDU, heterosexual, or MSM) risk group.
  • Current HIV viral load was a significant predictor of HCV viral load, with a 1 log increase in HIV RNA associated with 17% higher HCV RNA.
  • Patient age, sex, race/ethnicity, region, hepatitis B status, CD4 cell count, and type of ART were not significant predictors of HCV RNA level.

Based on these findings, the researchers concluded that deferring hepatitis C treatment for a short time would not lead to a major increase in HCV viral load -- though the rise could be clinically important over the long term.

They added that combination ART that suppresses HIV RNA may improve the likelihood of sustained virological response (SVR) to hepatitis C therapy indirectly, by lowering HCV RNA levels, as lower HCV viral load is a well-established predictor of better treatment outcomes.

Investigator affiliatiosn: UCL Royal Free Campus, Medical School, London, UK; Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark; Hospital Carlos III, Infectious Diseases, Madrid, Spain; Bonn University Hospital, Infectious Diseases, Bonn, Germany.



D Grint, L Peters, J. Reekie, et al. (EuroSIDA). Predictors of Hepatitis C RNA Levels in HIV Co-infected Individuals in a Prospective Cohort Study. 13th European AIDS Conference (EACS 2011). Belgrade, October 12-15, 2011. Abstract PS7/3.