By Anne Harding

NEW YORK (Reuters Health) Aug 31 - Co-infection with hepatitis C virus (HCV) impairs immune restoration in patients with HIV starting highly active antiretroviral therapy (HAART), a new meta-analysis of eight trials including 6,216 patients demonstrates.

After 48 weeks on HAART, the CD4 counts of patients co-infected with HCV were 33.4 cells/mm3 lower than for those who did not have HCV infection, Dr. Christopher F. Rowley of Beth Israel Deaconess Medical Center in Boston and colleagues found.

Thirty percent of people with HIV are co-infected with HCV, Dr. Rowley and his team note in their report in the Sept. 1 issue of Clinical Infectious Diseases. Studies have suggested that HCV infection may impair immune restoration by HAART, and there are questions as to whether co-infected patients should begin HAART earlier for optimal immune restoration as well as whether HCV should be eradicated before HAART treatment begins.

"The real reason why we did the meta-analysis in the first place is because it was an area of controversy and still remains an area of controversy," Dr. Rowley told Reuters Health.

Hepatitis C treatment carries severe side effects, including flu-like symptoms and depression, he noted. While frequently updated guidelines are available on when HAART should begin, based on a patient's CD4 count, there are no such guidelines for HCV treatment, he added.

The current study was unable to determine whether lower CD4 counts had any effect on virologic or clinical outcomes, the researchers note, while the best time to start HCV treatment in co-infected patients also remains unclear.

"Additional prospective studies need to be conducted to provide the definitive answer to patients and clinicians, so that both infections can be treated in the most effective manner," they conclude.

The next step, Dr. Rowley said, will be to determine if lower CD4 counts translate to worse virologic and clinical outcomes.

Clin Infect Dis 2005;41:713-720.

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