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Survival in AIDS: Does an Obscure Virus Make a Difference?

The widely variable survival time after HIV infection always has been a mystery. Now the plot thickens: Coinfection with a newly described, and still poorly understood, flavivirus correlates with a substantial survival advantage among HIV-infected people. GB virus C (GBV-C), originally isolated from hepatitis patients in the 1990s, was called hepatitis G virus until researchers determined that it did not cause hepatitis or, in fact, any known human illness. It is a fairly common bloodborne virus: About 2 percent of healthy U.S. blood donors are infected.

Iowa investigators followed 144 HIV-infected patients with PCR evidence of GBV-C coinfection and 218 HIV-infected patients without coinfection. After a median of 4.1 years, overall mortality was significantly lower in coinfected patients (28 percent vs. 56 percent). The same pattern held when patients were stratified by CD4 cell count, even among those with fewer than 50 CD4 cells/mm³ at study entry.

Among 197 HIV-infected patients, German researchers found that 33 with active GBV-C infection had longer times to AIDS diagnoses and longer overall survival than did 52 with no evidence of GBV-C exposure. In addition, both parameters were longer among coinfected patients than among the remaining 112 patients with antibodies against GBV-C (indicating exposure to the virus) but no active infection. In vitro studies also were performed: Plasma HIV viremia and plasma GBV-C viremia were inversely correlated, and GBV-C appeared to suppress HIV replication in cell culture.

Comment: Does GBV-C enter HIV-infected cells and somehow hinder HIV replication? Or is it simply a marker for other, yet undiscovered, biological parameters of survival in AIDS? Editorialists caution that this intriguing association must be explored further before thoughts of HIV therapy with GBV-C are entertained.

— A Zuger

Published in Journal Watch General Medicine September 18, 2001

Citation(s):

Xiang J et al. Effect of coinfection with GB virus C on survival among patients with HIV infection. N Engl J Med 2001 Sep 6 345 707-714.

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Tillmann HL et al. Infection with GB virus C and reduced mortality among HIV-infected patients. N Engl J Med 2001 Sep 6 345 715-724.

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• Medline abstract (Free)

Stosor V and Wolinsky S. GB virus C and mortality from HIV infection. N Engl J Med 2001 Sep 6 345 761-762.

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• Medline abstract (Free)