Systematic review and meta-analysis of hepatitis C virus infection and HIV viral load: New insights into epidemiologic synergy

• Authors: Patrick S Sullivan, Emory University; Nicholas Petersdorf, University of London; Jennifer M. Ross, University of Washington, Seattle; Helen A. Weiss, University of London; Ruanne V. Barnabas, University of Washington, Seattle; Judith N. Wasserheit, University of Washington, Seattle
• Journal Title: Journal of the International AIDS Society
• Volume: Volume 19, Number 1
• Publisher: Wiley Open Access | 2016-01-01, Pages 20944-20944
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7448/IAS.19.1.20944
• Subjects: Health Sciences, Epidemiology; Health Sciences, Immunology
• Keywords: HCV; HIV; co-infection; hepatitis C virus; systematic review; viral load; Antiviral Agents; Coinfection; HIV Infections; Hepacivirus; Hepatitis C; Humans; Viral Load

Abstract

Introduction: Hepatitis C virus (HCV) and HIV infection frequently co-occur due to shared transmission routes. Co-infection is associated with higher HCV viral load (VL), but less is known about the effect of HCV infection on HIV VL and risk of onward transmission. Methods: We undertook a systematic review comparing 1) HIV VL among ART-naýve, HCV co-infected individuals versus HIV mono-infected individuals and 2) HIV VL among treated versus untreated HCV co-infected individuals. We performed a randomeffects meta-analysis and quantified heterogeneity using the I 2 statistic. We followed Cochrane Collaboration guidelines in conducting our review and PRISMA guidelines in reporting results. Results and discussion: We screened 3925 articles and identified 17 relevant publications. A meta-analysis found no evidence of increased HIV VL associated with HCV co-infection or between HIV VL and HCV treatment with pegylated interferon-alpha-2a/b and ribavirin. Conclusions: This finding is in contrast to the substantial increases in HIV VL observed with several other systemic infections. It presents opportunities to elucidate the biological pathways that underpin epidemiological synergy in HIV co-infections and may enable prediction of which co-infections are most important to epidemic control.