The impact of DAA-mediated HCV eradication on CD4+ and CD8+ T lymphocyte trajectories in HIV/HCV coinfected patients: Data from the ICONA Foundation Cohort

Bandera A;Lorenzini P;Taramasso L;Cozzi-Lepri A;Lapadula G;Mussini C;Saracino A;Ceccherini-Silberstein F;Puoti M;Quiros-Roldan E;Montagnani F;Antinori A;d’Arminio Monforte A;Gori A;Andreoni M.;Castagna A.;Castelli F.;Cauda R.;Di Perri G.;Galli M.;Iardino R.;Ippolito G.;Lazzarin A.;Marchetti G. C.;Rezza G.;von Shloesser F.;Viale P.;Castagna A.;Girardi E.;Lo Caputo S.;Maggiolo F.;Perno C. F.;Bai F.;Bonora S.;Borderi M.;Calcagno A.;Capobianchi M. R.;Castagna A.;Cicalini S.;Cingolani A.;Cinque P.;Di Biagio;Gagliardini R.;Girard E.;Gianotti N.;Guaraldi G.;Lichtner M.;Lai A.;Madeddu G.;Maggiolo F.;Marchetti G.;Merlini E.;Nozza S.;Perno C. F.;Picon S.;Pinnetti C.;Rossotti R.;Rusconi S.;Santoro M. M.;Sarmati L.;Spagnuolo V.;Svicher V.;Fanti I.;Galli L.;Rodano’ A.;Macchia M.;Tavelli A.;Bove A.;Camposeragna A.;Errico M.;Manfredini M.;Perziano A.;Calvino V.;Carletti F.;Carrara S.;Di Caro A.;Graziano S.;Petroni F.;Prota G.;Truffa S.;Giacometti A.;Costantini A.;Barocci V.;Angarano G.;Monno L.;Milano E.;Maggiolo F.;Suardi;Viale P.;Donati V.;Verucchi G.;Castelnuovo F.;Minardi C;Menzaghi B.;Abeli C.;Chessa L.;Pes F.;Cacopardo B.;Celesia B.;Vecchiet J.;Falasca K.;Pan A.;Lorenzotti S.;Sighinolfi L.;Segala D.;Blanc P.;Vichi F.;Cassola G.;Bassetti M.;Alessandrin A.;Bobbio N.;Mazzarello G.;Lichtner M.;Fondaco L.;Bonfanti P.;Molteni C.;Chiodera A.;Milini P.;Nunnari G.;Pellicanò G.;Galli M.;Lazzarin A.;Rizzardini G.;Castagna A.;Cannizzo E. S.;Moioli M. C.;Piolini R.;Bernacchia D.;Poli A.;Tincati C.;Puzzolante C.;Migliorino C.;Sangiovanni V.;Borgia G.;Esposito V.;Di Flumeri G.;Gentile I.;Rizzo V.;Cattelan A. M.;Marinello S.;Cascio A.;Trizzino M.;Francisci D.;Schiaroli E.;Parruti G.;Sozio F.;Lazzaretti C.;Corsini R.;Andreoni M.;Cauda R.;Cristaudo A.;Vullo V.;Acinapura R.;Lamonica S.;Capozzi M.;Mondi A.;Cingolani A.;Rivano Capparuccia M.;Iaiani G.;Latini A.;Onnelli G.;Plazzi M. M.;De Girolamo G.;Vergori A.;Cecchetto M. Viviani F;Madeddu G.;De Vito A.;Rossetti B.;Franco A.;Fontana Del Vecchio R.;Di Giuli C.;Caramello P.;Di Perri G.;Bonora S.;Orofino G. C.;Sciandra M.;Londero A.;Manfrin V.;Battagin G.;Starnini G.;Ialungo A

2021-01-01

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Abstract

HCV infection has been hypothesized as a contributor of poor CD4+ recovery in patients living with HIV (PLWHIV). Aim of this study was to evaluate CD4+ , CD8+ cells and CD4/CD8 ratio trends before and after HCV treatment with direct acting agents (DAA) in PLWHIV. HIV/HCV patients enrolled in ICONA and HepaICONA cohorts with HIV-RNA≤50 copies/ml who achieved a sustained viral response after DAA treatment were studied. A linear regression model was used to investigate CD4+ , CD8+ and CD4/CD8 changes 12 months before and after DAA treatment. A total of 939 HIV/HCV patients were included, 225 (24.0%) female, median age: 53 years (IQR 50-56). At DAA initiation, CD4+ T cell count was <350 cells/mm3 in 164 patients (17.5%), and 246 patients (26.2%) had liver stiffness>12.5 kPa. Trends of CD4+ and CD4/CD8 ratio were similar before and after DAA in all study populations (CD4+ change +17.6 cells/mm3 (95%CI -33.5; 69.4, p = 0.494); CD4/CD8 change 0.013 (95%CI -0.061; 0.036, p = 0.611). However, patients treated with ribavirin (RBV)-free DAA showed a significant decrease in CD8+ cells (-204.3 cells/mm3 , 95%CI -375.0;-33.4, p = 0.019), while patients treated with RBV experienced CD8+ cell increase (+141.2 cells/mm3 , 95%CI 40.3; 242.1, p = 0.006). In conclusion, HCV eradication following DAA treatment does not seem to have an impact on CD4+ T cell recovery in PLWHIV. However, a fast decline of CD8+ T cells has been observed in patients treated without RBV, suggesting a favourable effect of HCV clearance on the general state of immune activation.