Effect of Coinfection with GB Virus C on Survival among Patients with HIV Infection
Jinhua Xiang, M.D., Sabina Wunschmann, Ph.D., Daniel J. Diekema, M.D., Donna Klinzman, B.A., Kevin D. Patrick, M.A., Sarah L. George, M.D., and Jack T. Stapleton, M.D.
Background Previous studies have suggested that people withhuman immunodeficiency virus (HIV) infection who are coinfectedwith GB virus C (GBV-C, or hepatitis G virus) have delayed progressionof HIV disease. GBV-C is related to hepatitis C virus but doesnot appear to cause liver disease.
Methods We examined the effect of coinfection with GBV-C onthe survival of patients with HIV infection. We also evaluatedcultures of peripheral-blood mononuclear cells infected withboth viruses to determine whether GBV-C infection alters replicationin vitro.
Results Of 362 HIV-infected patients, 144 (39.8 percent) hadGBV-C viremia in two tests. Forty-one of the patients with GBV-Cviremia (28.5 percent) died during the follow-up period, ascompared with 123 of the 218 patients who tested negative forGBV-C RNA (56.4 percent; P<0.001). The mean duration of follow-upfor the entire cohort was 4.1 years. In a Cox regression analysisadjusted for HIV treatment, base-line CD4+ T-cell count, age,sex, race, and mode of transmission of HIV, the mortality rateamong the 218 HIV-infected patients without GBV-C coinfectionwas significantly higher than that among the 144 patients withGBV-C coinfection (relative risk, 3.7; 95 percent confidenceinterval, 2.5 to 5.4). HIV replication, as measured by the detectionof p24 antigen in culture supernatants, was reproducibly inhibitedin cultures of peripheral-blood mononuclear cells by GBV-C coinfection.Coinfection did not alter the surface expression of HIV cellularreceptors on peripheral-blood mononuclear cells, as determinedby flow cytometry.
Conclusions GBV-C infection is common in people with HIV infectionand is associated with significantly improved survival.
Source Information
From the Departments of Internal Medicine and Research, Iowa City Veterans Affairs Medical Center, and the University of Iowa College of Medicine (J.X., S.W., D.J.D., D.K., K.D.P., S.L.G., J.T.S.), and the Helen C. Levitt Center for Viral Pathogenesis and Disease (J.T.S.) — all in Iowa City, Iowa.
Address reprint requests to Dr. Stapleton at the Department of Internal Medicine, SW 54, GH UIHC, 200 Hawkins Dr., University of Iowa, Iowa City, IA 52242, or at jack-stapleton{at}uiowa.edu.
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