Effect of Hepatitis G Virus Infection on Progression of HIV Infection in Patients with Hemophilia

Effect of Hepatitis G Virus Infection on Progression of HIV Infection in Patients with Hemophilia

Anthony E.T. Yeo, MD, MPH, PhD;
Akihiro Matsumoto, MD, PhD;
Michie Hisada, MD, ScD;
James W. Shih, PhD;
Harvey J. Alter, MD;
James J. Goedert, MD; and
for the Multicenter Hemophilia Cohort Study*

From the National Institutes of Health, Bethesda, Maryland.

Abstract

Background: Infection with hepatitis G virus (HGV), also known as GB virus C, is prevalent but is not known to be associated with any chronic disease. Infection with HGV may affect the risk for AIDS in HIV-infected persons.

Objective: To compare AIDS-free survival in patients with and those without HGV infection during 16 years of follow-up after HIV seroconversion.

Design: Subanalysis of a prospective cohort study.

Setting: Comprehensive hemophilia treatment centers in the United States and Europe.

Patients: 131 patients with hemophilia who became HIV-positive between 1978 and 1985.

Measurements: Age, CCR5 genotype, HIV and HCV viral loads, CD4⁺ and CD8⁺ lymphocyte counts, and 12-year AIDS-free survival by HGV positivity (viremia [RNA] or anti-E2 antibodies).

Results: Compared with HGV-negative patients, the 60 HGV-positive patients (46%), including 22 who were positive for HGV RNA, had higher CD4⁺ lymphocyte counts (difference, 211 cells/mm³ [95% CI, 88 to 333 cells/mm³]) and 12-year AIDS-free survival rates (68% compared with 40%; rate difference, 1.9 per 100 person-years [CI, −0.3 to 4.2 per 100 person-years]), despite similar ages and HIV viral loads. In multivariate proportional hazards models, risk for AIDS was 40% lower for HGV-positive patients independent of age, HIV and HCV viral loads, CD4⁺ and CD8⁺ lymphocyte counts, and CCR5 genotype.

Conclusions: Patients with past or current HGV infection have higher CD4⁺ lymphocyte counts and better AIDS-free survival rates. The mechanism of this association is unknown.

*For a list of collaborators in the Multicenter Hemophilia Cohort Study, see the Appendix.

Article and Author Information

Acknowledgments: The authors thank Dr. Frances Yellin (Computer Science Corp.) for computer programming and Virginia Lamprecht and Dr. Barbara Kroner (Research Triangle Institute) for study management. They especially thank the study participants, the hemophilia center staff, and the collaborators of the Multicenter Hemophilia Cohort Study for their tireless contributions.
Contract Support: In part by National Cancer Institute contract N01-CP-33002 with Research Triangle Institute.
Requests for Single Reprints: James J. Goedert, MD, Viral Epidemiology Branch, National Cancer Institute, 6120 Executive Boulevard, Room 8012 MSC 7248, Rockville, MD 20852; e-mail, goedertj{at}mail.nih.gov.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Yeo, Shih, and Alter: National Institutes of Health, Warren Grant Magnuson Clinical Center, Department of Transfusion Medicine, Room 1C711, MSC 1184, Bethesda, MD 20892.
Dr. Matsumoto: Second Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano-ken 390-8621, Japan.
Drs. Hisada and Goedert: Viral Epidemiology Branch, National Cancer Institute, 6120 Executive Boulevard, Room 8012 MSC 7248, Rockville, MD 20852.
Author Contributions: Conception and design: J.W. Shih, H.J. Alter, J.J. Goedert.
Analysis and interpretation of the data: A.E.T. Yeo, M. Hisada, H.J. Alter, J.J. Goedert.
Drafting of the article: A.E.T. Yeo, H.J. Alter, J.J. Goedert.
Critical revision of the article for important intellectual content: A.E.T. Yeo, A. Matsumoto, H.J. Alter.
Final approval of the article: M. Hisada, H.J. Alter, J.J. Goedert.
Statistical expertise: A.E.T. Yeo, M. Hisada, J.J. Goedert.
Obtaining of funding: J.J. Goedert.
Administrative, technical, or logistic support: J.W. Shih, J.J. Goedert.
Collection and assembly of data: A. Matsumoto, M. Hisada, J.J. Goedert.