Abstract
IntroductionHIV‐controllers have the ability to spontaneously maintain viraemia at low or undetectable levels in the absence of antiretroviral treatment. Furthermore, HIV‐controllers seem to have a superior capacity to spontaneously clear hepatitis C virus (HCV) compared to non HIV‐controllers. Some of these subjects eventually lose HIV‐controller status (transient controllers), whereas some HIV‐controllers show a persistent natural HIV control (persistent controllers). We aimed to analyse whether persistent controllers have superior capacity to spontaneously clear HCV compared to transient controllers.MethodsWe recruited HIV‐controllers from January 1981 up to October 2016 with available antibodies to HCV (anti‐HCV) data (n = 744). Factors associated with HIV spontaneous control in relation to HCV status were analysed in persistent and transient HIV‐controllers with anti‐HCV positive (n = 202 and n = 138 respectively) in comparison with 1700 HCV positive non HIV‐controllers recruited from January 1981 up to March 2018, bivariate and multivariate analyses, following a logistic regression model, were applied. In addition, the factors related to the loss and time to lose HIV‐controller status were explored (n = 744) using Log rank test and Kaplan–Meier curves, in this case the multivariate analysis consisted in a Cox regression model.ResultsA higher frequency of HCV spontaneous clearance was found in persistent HIV‐controllers (25.5%) compared to non‐controllers (10.2%). After adjusting for potential confounders, as sex, age, HIV transmission risk, CD4+ T‐cell nadir and time of follow‐up, HCV clearance was independently associated with persistent HIV spontaneous control (p = 0.002; OR (95% CI) = 2.573 (1.428 to 4.633)), but not with transient spontaneous control (p = 0.119; 1.589 (0.888 to 2.845)). Furthermore, persistent HIV‐controllers were more likely to spontaneously clear the HCV in comparison with transient controllers (p = 0.027; 0.377 (0.159 to 0.893). Finally, not to lose or lengthen the time of losing this control was independently associated with HCV spontaneous clearance (p = 0.010; 0.503 (0.297 to 0.850).ConclusionsThis study shows an association between spontaneous persistent HIV‐control and HCV spontaneous clearance. The study findings support the idea of preserved immune mechanisms in persistent HIV control implicated in HCV spontaneous clearance. These results highlight persistent HIV‐controllers but not transient controllers as a good model of functional HIV cure.
Highlights
HIV-controllers have the ability to spontaneously maintain viraemia at low or undetectable levels in the absence of antiretroviral treatment
CI, confidence interval;.OR, odd ratio; people who inject drugs as (PWID), people who inject drug. aTime period between HIV diagnosis and loss of HIV-controller status or last monitored visit point; bclinical stage C data from 107 persistent HIV-controllers, 121 transient HIV-controllers and 1674 non-controllers; cHCV polymerase chain reaction (PCR) + was considered before hepatitis C virus (HCV) treatment onset in those who were treated; dHCV genotype detected from 132 persistent HIV-controllers, 84 transient HIVcontrollers and 1075 non-controllers; efor HCV spontaneous clearance calculation we only considered patients with available data of anti-HCV, HCV PCR and HCV treatment. 94 persistent HIV-controllers, 117 transient HIV-controllers and 1694 non-controllers accomplished all data. ; fHLA-B*57 data from 79 persistent HIV-controllers, 56 transient HIV-controllers and 818 noncontrollers
HCV PCR+ was considered before HCV treatment onset in those who were treated; dHCV viral load (VL) data from 96 persistent controllers and 101 transient controllers; eHCV genotype detected in 70 persistent controllers, and 84 transient controllers; ffor HCV spontaneous clearance calculation we only considered patients with anti-HCV+ and available data of HCV PCR and HCV treatment
Summary
HIV-controllers are a small group of subjects (
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