Background: An increase in hepatitis C virus (HCV) incidence among HIV-positive men who have sex with men (MSM) has been documented since 2000. Unlike most studies examining the effect of HIV/HCV-coinfection among individuals acquiring HCV before HIV, HIV precedes HCV infection for the majority of MSM. We aim to assess the effect of HCV infection and its timing, relative to HIV seroconversion, on CD4 T-cell count (CD4) and HIV RNA (VL) evolution among HIV-positive MSM.
Methods: We included MSM with well-estimated dates of HIV seroconversion (HIVsc) from 17 cohorts in the CASCADE Collaboration within EuroCoord. Each newly HCV-infected individual was matched to two HCV-negative ones. We also matched on country of the cohort in ART naïve, and on time since start cART use for MSM on cART. We modeled trends of CD4 and VL using random effects models with the time origin for each triad of individuals aligned on time since HIVsc at HCV infection of the HIV/HCV-coinfected one. We used restricted cubic splines for continuous variables. We included as co-variables: interval from HIV to HCV infection, age at HIVsc and, for those on cART, time since cART initiation.
Results: Of 6,325 ART-naïve MSM and 4,856 MSM on cART, 262 and 149 were/became HIV/HCV-coinfected, respectively. HCV infection had a borderline significant effect on VL evolution among ART-naïve MSM, but its effect was not statistically significant among MSM on cART (p=0.05 and p=0.93, respectively). HCV infection timing had no effect on VL evolution (p=0.07 ART-naïve & p=0.54 on cART). The effect of HCV-infection on the CD4 evolution following HCV was highly significant while ART-naïve and when on cART (both p< 0.001), but did not differ by HCV infection timing (p=0.45 and p=0.54, respectively). CD4 were temporarily lower during the first two years after HCV infection compared to HIV-monoinfected individuals, especially among MSM who seroconverted for HIV at older ages. Lower CD4 was more pronounced on cART.
Conclusions: Among HIV-positive MSM, CD4 are temporarily lower during the first two years after HCV seroconversion, irrespective of cART usage. However, we found no significant effect of the timing of HCV infection on the evolution of CD4 or VL.

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