Factors associated with hepatitis C viremia in a large cohort of HIV-infected and -uninfected women

Background: Co-infection with hepatitis C virus (HCV) is common among HIV-infected women. Objective: To further our understanding of the risk factors for HCV viremia and the predictors of HCV viral load among women. Study design: We investigated sociodemographic, immunologic, and virologic factors associated with presence and level of HCV viremia among 1049 HCV-seropositive women, 882 of whom were HIV-infected and 167 HIV-uninfected at their entry into the Women's Interagency HIV Study. Results: Plasma HCV RNA was detected in 852 (81%) of these 1049 women (range: 1.2-7.8 log₁₀ copies/ml). HCV-viremic women were more likely to have an HIV RNA level >100,000 copies/ml (P = 0.0004), to have reported smoking (P = 0.01), or to be Black (P = 0.005). They were less likely to have current or resolved hepatitis B infection. HCV RNA levels were higher in women who were >35 years old, or HIV-infected. Current smoking and history of drug use (crack/freebase cocaine, marijuana, amphetamines, or heroin) were each associated with both presence and level of viremia. Conclusions: Substance abuse counseling aimed at eliminating ongoing use of illicit drugs and tobacco may reduce clinical progression, improve response to treatment, and decrease HCV transmission by lowering levels of HCV viremia in women.