The impact of DAA‐mediated HCV eradication on CD4<sup>+</sup> and CD8<sup>+</sup> T lymphocyte trajectories in HIV/HCV coinfected patients: Data from the ICONA Foundation Cohort
Alessandra Bandera, P Lorenzini, Lucia Taramasso, Alessandro Cozzi‐Lepri, Giuseppe Lapadula, Cristina Mussini, Annalisa Saracino, Francesca Ceccherini‐Silberstein, Massimo Puoti, Eugenia Quirós-Roldán, Francesca Montagnani, Andrea Antinori, Antonella d’Arminio Monforte, Andrea Gori
Abstract
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/mm 3 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/mm 3 (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/mm 3 , 95%CI −375.0;‐33.4, p = 0.019), while patients treated with RBV experienced CD8 + cell increase (+141.2 cells/mm 3 , 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.