Background: Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) co-infection is reported to be common among HIV infected subjects due to share routes of transmission. The fact that HCV infection may act as cofactor for HIV disease progression has been suggested.\ud
Objective: To determine if HCV and HIV co-infection affect the immunocompetence (CD4) of the infected subjects and response to Highly Active Anti Retroviral therapy.\ud
Subjects and methods: Fifty HIV/HCV co-infected and fifty HIV monoinfected adults were retrospectively studied. Their baseline CD4 cell counts were done using Dynal beads technique before commencement of HAART and repeated after six months.\ud
Results: The CD4 cell counts of co-infected subjects were lower than the mono-infected subjects. Sixty eight percent of the co-infected subjects had CD4 cell count less than 200cells/uL, and they responded poorly to HAART therapy than the mono-infected subjects (P<0.05). Those with CD4 cell count greater than 200cells/uL responded better to treatment than those with CD4 cell count less than 200cells/uL (P<0.001)\ud
Conclusion: HCV/HIV co-infection affects the immunocompetence of the patients and HCV may acts as cofactor for HIV disease progression. It is needful to screen all HIV positive subjects for HCV antibody as this will improve their clinical management and outcome

Emokpae, MA

Jegede, EE

Nwokedi, EE

English

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Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects

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Published Quarterly
Mangalore, South India
ISSN 0972-5997
Volume 7, Issue 2; Apr-Jun 2008
Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects  
Authors
Emokpae MA,
Department Of Chemical Pathology, Aminu Kano Teaching Hospital, P.M.B 3452, Kano,
Nwokedi EE,
Department Of Medical Microbiology And Parasilogy, Faculty Of Medicine, Bayero University, Kano
Jegede EE,
Department Of Haematology And Blood Group Serology Aminu Kano Teaching Hospital, Kano.
Address For Correspondence
Emokpae MA,
Department Of Chemical Pathology,
Aminu Kano Teaching Hospital,
P.M.B 3452, Kano
E-mail: biodunemokpae@yahoo.com
Citation
Emokpae MA, Nwokedi EE, Jegede EE. Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects. Online  
J Health Allied Scs. 2008;7(2):3
URL
http://www.ojhas.org/issue26/2008-2-3.htm
http://ojhas.org 1
OJHAS Vol 7 Issue 2(3)  Emokpae MA, Nwokedi EE, Jegede EE. Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects
 Original Article
Submitted: Jun 25, 2008; Accepted: June 29, 2008; Published: July 21, 2008
Abstract:
Background: Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) co-infection is reported to be common 
among HIV infected subjects due to share routes of transmission. The fact that HCV infection may act as cofactor for HIV 
disease progression has been suggested.
Objective: To determine if HCV and HIV co-infection affect the immunocompetence (CD4) of the infected subjects and 
response to Highly Active Anti Retroviral therapy.
Subjects and methods: Fifty HIV/HCV co-infected and fifty HIV monoinfected adults were retrospectively studied. Their 
baseline CD4 cell counts were done using Dynal beads technique before commencement of HAART and repeated after six 
months.
Results: The CD4 cell counts of co-infected subjects were lower than the mono-infected subjects. Sixty eight percent of the 
co-infected subjects had CD4 cell count less than 200cells/uL, and they responded poorly to HAART therapy than the 
mono-infected subjects (P<0.05). Those with CD4 cell count greater than 200cells/uL responded better to treatment than 
those with CD4 cell count less than 200cells/uL (P<0.001)
Conclusion: HCV/HIV co-infection affects the immunocompetence of the patients and HCV may acts as cofactor for HIV 
disease progression. It is needful to screen all HIV positive subjects for HCV antibody as this will improve their clinical 
management and outcome.
Key Words: Hepatitis C, Human Immunodeficiency virus, CD4 cell count, Co-infection
Introduction:
This study was aimed at determining if Hepatitis C(HCV) 
and  Human  Immunodeficiency  virus  (HIV)  co-infection 
affect the immunocompetence (CD4) of the subjects and 
response  to  Highly  Active  Anti  Retroviral  Therapy 
(HAART).  Co-infection  with  Hepatitis  B  or  HCV  is 
reported to be common among HIV infected subjects in 
various countries. In Nigeria, a prevalence of 6.2% of co 
infection  of  HCV and HIV was  recently  reported from 
this  centre.(1)  This  is  also  true  when  compared  with 
other  parts  of  Nigeria.(2)  Co  infection  prevalence  of 
12.5%  was  also  reported  among  selected  subjects  in 
Abuja,  Nigeria.(3)  A  co  infection  prevalence  rates  in 
Africa varies between 0.41 and 12 %(4). Recent reports 
suggest that the prevalence in normal Africans may be as 
high as 10.9% while the corresponding value for patients 
with primary liver cell  carcinoma may be about  18.7 - 
38%.(4) Similarly Backus et al(5) reported prevalence rate 
of 37% among high risk group in USA. They reported that 
co-infected patients were older, more likely to be men, 
more likely to be blacks or Hispanic and more likely to 
report  intravenous  drug  use  as  a  risk  factor  for  HIV 
acquisition.  Co infections  by both viruses  are  frequent 
given  the  share  routes  of  transmission.  Before  the 
introduction of HAART, in HIV management the impact 
of  HCV was  limited given the morbidity  and mortality 
related  to  HIV  infection.(6)  In  this  era  however,  when 
there is significant decrease in morbidity and mortality 
amongst  HIV infected patients,  the expression of  liver-
related complications associated with HCV often occur.
(1,3)  There  are  however  conflicting  reports  on  the 
impact  of  HCV  on  HIV  co-infection.  According  to 
recommendations from an international experts panel on 
care  of  patients  with  chronic  HBV/HCV  co  infection, 
some  authors  reported  that  HIV  disease  outcomes 
following HAART do not appear to be adversely affected 
by  HBV/HCV  co-infection,  while  others  said  that  even 
though HIV is known to worsen HCV liver disease  the 
impact of HCV on HIV is not clear and no impact of HCV 
co-infection  on  HIV  as  well  as  overall  mortality  (7) 
HAART was not available in this  country until  the year 
2002  when  the  Federal  government  of  Nigeria 
introduced it to reduce the impact of HIV/AIDS. The CD4 
cell counts of these patients  treated with HAART were 
also not available in this centre until January 2002 when 
the  government  of  Nigeria  introduced  the  accelerated 
HAART trial in six centres in this country of which Aminu 
Kano Teaching Hospital was one. The impact of HCV-HIV 
co-infection on CD4 cell count is therefore presented.
Subjects and Methods:
One hundred newly diagnosed HIV positive adults, aged 
20 years  and above were  retrospectively  studied.  They 
consist of fifty HIV/HCV co-infected and fifty HIV mono 
infected  subjects.  They  were  counseled  and  relevant 
confidentiality  was  maintained  throughout  the  study. 
Informed  consent  was  obtained  from  the  patients. 
Inclusion criteria for enrolment of patients include: that 
patients must be male and female adults that is 20years 
and above,  must have laboratory  evidence of  HIV and 
HCV co-infection, must not have history of having taken 
any  form  of  antiretroviral  therapy.  Ten  millilitres  of 
blood  was  obtained  from  each  patient  and  the 
specimens were analyzed to establish the baseline values 
of  CD4  cell  count.  The  samples  were  also  used  to 
confirm the serostatus of all patients tested outside the 
hospital.
The HIV serostatus was confirmed by testing each patien-
t’s  serum using  double  rapid  test  kits  Capillus  (Trinity 
Biotech, Ireland), Genie II HIV 1 and 2 (Biorad, USA) and 
Immunocomfirm (Orgenics, Israel). HCV antibody testing 
was done using ELISA technique (HCV Murex 40, Anhet 
laboratories, USA).
Baseline CD4 cell count of each patient was determined 
using Dynal beads technique prior to commencement of 
HAART. The CD4 counts were repeated at six months in-
terval after commencement of treatment and complete 
adherence to treatment by patients. The CD4 cell count 
of  the  co-infected  patients  was  compared  with  HIV 
mono- infected subjects after six months interval respec-
tively.  The  investigations  were  carried  out  before  the 
commencement of the US president emergency plan for 
AIDS relief (PEPFAR) and Global Fund programs.
Results:
The CD4 cell counts of the 50 HIV/HCV co-infected sub-
jects as well as 50 HIV monoinfected subjects before and 
after commencement of HAART are presented in Tables 
1-3.  The CD4 cells  count  of  HIV/HCV co-infected  was 
stratified  based on  the  number of  CD4 cells  count.  It 
shows that 15(30%) of the subjects had CD4 cell count of 
0-99, while 19(38%), 12(24%) and 4(8%) of the patients 
had CD4 cells count of 100-199,200-299 and 300-399 re-
spectively. It also shows that 34(68%) of the co-infected 
subjects  had  CD4  cells  count  below  200cells/ul  while 
16(32%) had CD4 cells count above 200cell/ul.
http://ojhas.org 2
OJHAS Vol 7 Issue 2(3)  Emokpae MA, Nwokedi EE, Jegede EE. Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects
Table 1: Baseline CD4 cell count of HIV/HCV co-infected subjects 
CD4 cell count-
Cell/ul
Age Interval
<20 20-29 30-39 40-49 Total(%)
0-99 - 10 5 - 15(30)
100-199 - 5 10 4 19(38)
200-299 1 5 2 4 12(24)
300-399 - 2 1 1 4(8)
Total (%) 1(2) 22(44) 18(36) 9(18) 50(100)
Table 2 shows the baseline CD4 cell count of HIV mono-
infected naïve  subjects.  It  shows  that  6(12%)  had  CD4 
cells count of 0-99, while 6(12%), 32(64%), and 6(12%) of 
the  patients  had  CD4 cells  count  of  100-199,  200-299 
and 300-399 respectively. Twelve 12(24%) of the patients 
had CD4 cells count below 200cells/ul while 38(76%) pa-
tients had CD4 cells count of above 200cells/ul.
Table 2: Baseline CD4 cell count of HIV mono-infected subjects 
CD4 cell count-
Cell/ul
Age Interval
<20 20-29 30-39 40-49 Total(%)
0-99 - 5 - 1 9(12)
100-199 - 2 2 2 6(12)
200-299 1 12 16 3 32(64)
300-399 - 2 3 1 6(12)
Total (%) 1(2) 21(42) 21(42) 7(14) 50(100)
Table  3 shows the CD4 cells  count  of  co-infected and 
mono-infected subjects before and after the commence-
ment of therapy. The CD4 cells count of the 34subjects 
whose initial CD4 cells count was 182±18 cells/uL before 
the commencement of HAART therapy rose to 202±25-
cells/uL after 6 months, while those of the 16 subjects 
whose CD4 cells count was initially 416±25cells/uL rose 
to 482±30 cells/uL after 6 months. A statistically signifi-
cant  difference  was  observed  (p<0.05).  For  the  HIV 
mono-infected subjects 12 of them who had CD4 cells 
count of 196±18cells/uL had their mean CD4 cells count 
appreciated  to 219±22 cells/uL  while  those  with mean 
CD4 cell count of 436±24ells/uL rose to 569±15 cells/uL 
after 6months. Statistically significant difference was also 
observed (p<0.001). When CD4 cells count of co-infected 
subjects were compared with mono infected subjects, a 
statistically significant difference was observed (p<0.001).
Table 3: CD4 Cell Count of HIV/HCV co-infected and HIV Mono-infected Subjects before and after HAART
 
Naive CD4 Count
<200 >200
6 Months on HAART - 
CD4 Count
p value
HIV/HCV Coinfected
(34) 182±18  202± 25 N/S
 (16) 416±25 482±30 p<0.05
HIV Monoinfected
(12) 192±18  219±22 N/S
 (38) 436±24 569±15 p<0.001
(Number of patients in parenthesis) 
Discussion:
The  CD4  cell  count  of  HIV/HCV  co-infected  naïve 
subjects  were  lower  than  those  of  HIV  mono-infected 
patients.  Similarly co-infected  individuals  responded 
poorly  to HAART therapy than mono-infected subjects. 
These were in agreement with other authors (4,6,7) who 
observed  poor  response  to  HAART  by  HIV  infected 
patients co-infected with HCV. The result also indicates 
that majority of the patients were diagnosed when their 
CD4 cell counts were below 200cells/uL. This was also in 
agreement  with  other  investigators.(1,8)  This  calls  for 
increased health education and expansion of  voluntary 
counseling and testing among the populace. Because of 
frequency of co-infection of both viruses due to shared 
routes of  transmission,  there is  need to screen all  HIV 
infected  individuals  for  hepatitis  C.  It  was  earlier 
reported  that  co-infection  of  HCV  may  influence  the 
natural history of HIV. HCV may worsen the spontaneous 
evolution  of  HIV  to  both  AIDS  and  death  in  affected 
subjects.(5)  HCV  infection  has  been  reported  as 
important factor in the morbidity  and mortality in HIV 
infected  subjects  which  may  be  due  to  impaired  CD4 
recovery  in  co-infected  patients  on  HAART.(7,9,10) 
Several mechanisms as to why HCV may act as a cofactor 
for HIV disease progression have been suggested. These 
include non-specific immune stimulation enhancing HIV 
replication and CD4 cell depletion reflecting infection of 
immune cells by HCV.(7)
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OJHAS Vol 7 Issue 2(3)  Emokpae MA, Nwokedi EE, Jegede EE. Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects
Those patients whose CD4 cells count were greater than 
200cells/uL responded better to HAART treatment than 
those whose CD4 cells were less than 200cells/uL. These 
have been documented by workers elsewhere.(7-8) Simi-
larly, the response of the HIV mono-infected individuals 
were  better  (p<0.001)  than  the  co-infected  subjects 
(p<0.05) to HAART. 
Conclusions:
The  CD4  cell  count  of  HIV/HCV  co-infected  subjects 
were lower than the HIV mono-infected subjects and the 
mono-infected patients responded to HAARt better than 
the co-infected patients. It is needful that HCV antibody 
be screened in all HIV positive patients so as to ascertain 
the status of their co-infection or not. This will in turn 
influence their clinical management as well as outcome.
References:
1. Nwokedi EE, Ilyasu Z, Emokpae MA, Dutse AI, 
Taura  AA.  Hepatitis  C  virus  infection  among 
Teaching Hospital patients in Kano, Nigeria: A 
Retrospective  study.  Annals  Afri  Med 
2006;5(4):185-87
2. Bojuwole  BJ.  The burden of viral  hepatitis  in 
Africa. West Afri J Med 1997;16:198-203
3. Odama  LE,  Mohammed  SE,  Audu  IG  et  al. 
Prevalence  of  Hepatitis  C  virus  amongst  HIV 
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4th National conference on HIV/AIDS in Nige-
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4. Ayodele OE,  Salako BL. Hepatitis  C virus and 
chronic  renal  disease.  Afri  J  Med  Sci 
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5. Backus, LI Boothroyd,  D Deyton, LR HIV,Hep-
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vulnerable  populations.  AIDS.  
2005;19(3):S13-19
6. Vallet-Pichard  A,  Pol S.  Hepatitis  Viruses  and 
HIV  Co-  infection:  Pathogenesis  and  treat-
ment. J Hepathol 2004;41(1):501-510
7. Soriano V, Puoti M, Bonacini M et al.  Recom-
mendations  from an  International  Expert  on 
Care of Patients with Chronic Hepatitis B and 
HIV  Coinfection 2005;  Internent  Conference 
reports.
8. Akolo CO. Impact of Hepatitis  B co-infection 
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http://ojhas.org 4
OJHAS Vol 7 Issue 2(3)  Emokpae MA, Nwokedi EE, Jegede EE. Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects


Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects

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