Acquisition of GB virus type C and lower mortality in patients with advanced HIV disease.

Pubmed ID: 22752515

Pubmed Central ID: PMC3657520

Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Publication Date: Oct. 1, 2012

Affiliation: Blood Systems Research Institute, Epidemiology, San Francisco, CA 94118, USA. fvahidnia@bloodsystems.org

MeSH Terms: Humans, Male, Adult, Female, HIV Infections, Middle Aged, Survival Analysis, Randomized Controlled Trials as Topic, Blood Component Transfusion, Flaviviridae Infections, GB virus C, Hepatitis, Viral, Human

Grants: R01 AI 058740, R01 AI058740

Authors: Custer B, Vahidnia F, Petersen M, Stapleton JT, Rutherford GW, Busch M

Cite As: Vahidnia F, Petersen M, Stapleton JT, Rutherford GW, Busch M, Custer B. Acquisition of GB virus type C and lower mortality in patients with advanced HIV disease. Clin Infect Dis 2012 Oct;55(7):1012-9. Epub 2012 Jul 2.

Studies:

Abstract

BACKGROUND: GB virus type C (GBV-C) is transmitted by sexual or parenteral exposure and is prevalent among patients receiving blood products. GBV-C is associated with lower human immunodeficiency virus (HIV) RNA and better survival among HIV-infected patients. Open questions are the presence and the direction of any causal relationship between GBV-C infection and HIV disease markers in the context of highly active antiretroviral therapy (HAART). METHODS: We used a limited access database obtained from the National Heart, Lung, and Blood Institute's Viral Activation Transfusion Study (VATS), a randomized controlled trial of leukoreduced vs nonleukoreduced transfusions to HIV-infected transfusion-naive patients. Blood samples from 489 subjects were tested for GBV-C markers. Cox regression models and inverse probability of treatment weights were used to examine the association between GBV-C coinfection and mortality in the VATS cohort. RESULTS: We found a significant reduction in mortality among GBV-C coinfected VATS subjects, after adjusting for HAART status, HIV RNA level, and CD4 cell count at baseline. Acquisition of GBV-C RNA (n = 39) was associated with lower mortality in 294 subjects who were GBV-C negative at baseline, adjusting for baseline covariates (hazard ratio = 0.22, 95% confidence interval [CI]: .08-.58) and in models in which weights were used to control for time-updated covariates (odds ratio = 0.21, 95% CI: .08-.60). CONCLUSIONS: GBV-C viremia is associated with lower mortality, and GBV-C acquisition via transfusion is associated with a significant reduction in mortality in HIV-infected individuals, controlling for HIV disease markers. These findings provide the first evidence that incident GBV-C infection alters mortality in HIV-infected patients.