Background: HCV infection is highly prevalent in HIV and is associated with excess liver-related and all-cause mortality. HCV cure decreases risk of hepatocellular carcinoma and liver-related mortality however the effect of HCV cure on other HIV associated morbidities is unclear. We examined the effect of HCV cure on markers of macrophage activation and microbial translocation (soluble CD163 and sCD14 respectively) which have been implicated in the pathogenesis of serious non-AIDS morbidities.
Methods: We studied 126 HIV/HCV coinfected Women´s Interagency HIV Study (WIHS) participants who had been successfully treated for HCV as of March 2018 and had available serum from pre- and post HCV treatment. HCV cure was defined as undetectable HCV RNA at least 12 weeks after completion of HCV therapy. sCD163 and sCD14 were measured in duplicate by ELISA (R&D Systems) on samples frozen at -80C. The final result was the mean of the duplicate tests. Multivariate analysis of variances was used to compare differences in log-transformed pre- and post- treatment sCD163 and sCD14.
Results: Participants were 52% African-American, 16% Hispanic, 20% other/multiracial. Pretreatment the mean age was 56.3 years, mean CD4 was 615, 72% had suppressed HIV RNA and 10% had cirrhosis by APRI or FIB-4. 114 participants had directly acting agent based HCV therapy and 12 had interferon based therapy. Results were similar when therapy groups were analyzed separately so results are presented for the full group. sCD163 and sCD14 significantly decreased from pre to post-treatment in unadjusted analyses (Table). In analyses using log-transformed values and adjusting for age, race, liver fibrosis stage, drug and alcohol use, CD4 and viral suppression status, the decrease in sCD163 and sCD14 remained significant.
Conclusions: Successful treatment of hepatitis C significantly decreased markers of microbial translocation and macrophage activation in HIV/HCV co-infected women. Larger, longitudinal analyses are needed to determine if these changes in markers predict reductions in HIV associated non-AIDS co-morbidities.