Correlates of HIV sustained viral suppression in HIV/hepatitis C virus coinfected patients: possible role of the hepatitis C virus sustained viral response.

BACKGROUND: The impact of hepatitis C virus (HCV)-related characteristics such as genotype, viral load or liver fibrosis on the chances of achieving sustained HIV suppression in coinfected patients is not fully documented. METHOD: We examined the relationship between both HIV/HCV-related and sociobehavioural characteristics and HIV sustained viral suppression (SVS) in 897 patients included in the ANRS CO13 HEPAVIH cohort. RESULTS: The main outcome variable was HIV SVS, defined as at least two consecutive undetectable HIV viral loads. Among the 897 HIV/HCV-coinfected patients, 419 (47%) had received HCV therapy at least once, and 103 patients (25%) had experienced an HCV sustained virologic response (SVR). In multivariate analysis, older age [odds ratio (OR) 1.23 for each period of 5 years of age, 95% confidence interval (CI) 1.02-1.49; P = 0.03], a higher level of school education (OR 1.92, 95% CI 1.04-3.56; P = 0.04), good adherence to HIV therapy (OR 2.05, 95% CI 1.23-3.43; P = 0.006) and HCV SVR (OR 1.81, 95% CI 1.01-3.26; P = 0.04) remained significantly associated with HIV SVS. In contrast, triple nucleoside reverse transcriptase inhibitor (NRTI) regimens were associated with failure to achieve HIV SVS (OR 0.50, 95% CI 0.27-0.94; P = 0.03). Our results show that HCV SVR is associated with a higher likelihood of achieving HIV SVS. CONCLUSION: With the advent of direct-acting anti-HCV drugs, a marked increase in the rate of virologic response is observed in coinfected patients. So, further research is needed to determine whether suppression of HCV replication could be associated with a higher efficacy of antiretroviral therapy.