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The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: a long-term retrospective cohort study.

Abstract
In this study we analyzed the influence of human immunodeficiency virus (HIV) infection on the course of chronic hepatitis C through multivariate analysis including age, alcohol consumption, immune status, and hepatitis C virus (HCV)-related virologic factors. Eighty HIV-positive and 80 HIV-negative injection drug users included between 1980 and 1995 were matched according to age, gender, and duration of HCV infection and followed-up during 52 months. The progression to cirrhosis was the primary outcome measure. The impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy, and liver-related death was also considered. In HIV-positive patients, chronic hepatitis C was characterized by higher serum HCV-RNA levels (P =.012), higher total Knodell score (P =.011), and poorer sustained response to interferon therapy (P =.009). High serum HCV-RNA level was associated with low CD4-lymphocyte count (P =.001). Necroinflamatory score was higher in HIV-positive patients (P =.023) independently of the CD4-lymphocyte count, whereas increased fibrosis was related to decreased CD4-lymphocyte count (P =.011). The progression to cirrhosis was accelerated in HIV-positive patients with low CD4 cell count (RR = 4.06, P =.024) and in interferon-untreated patients (RR = 4.76, P =.001), independently of age at HCV infection (P =.001). Cirrhosis caused death in 5 HIV-positive patients. The risk of death related to cirrhosis was increased in heavy drinkers (RR = 10.8, P =.001) and in HIV-positive patients with CD4 cell count less than 200/mm(3) (RR = 11.9, P =.007). In this retrospective cohort study, HIV coinfection worsened the outcome of chronic hepatitis C, increasing both serum HCV-RNA level and liver damage and decreasing sustained response to interferon therapy. Age and alcohol were cofactors associated with cirrhosis and mortality. Interferon therapy had a protective effect against HCV-related cirrhosis no matter what the patient's HIV status was.
AuthorsV Di Martino, P Rufat, N Boyer, P Renard, F Degos, M Martinot-Peignoux, S Matheron, V Le Moing, F Vachon, C Degott, D Valla, P Marcellin
JournalHepatology (Baltimore, Md.) (Hepatology) Vol. 34 Issue 6 Pg. 1193-9 (Dec 2001) ISSN: 0270-9139 [Print] United States
PMID11732009 (Publication Type: Journal Article)
Chemical References
  • Interferons
Topics
  • Adult
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Disease Progression
  • Female
  • HIV Infections (etiology, physiopathology)
  • HIV Seronegativity
  • Hepacivirus (isolation & purification)
  • Hepatitis C, Chronic (etiology, pathology, physiopathology, virology)
  • Humans
  • Immune System (physiopathology)
  • Interferons (therapeutic use)
  • Liver (pathology)
  • Liver Cirrhosis (etiology)
  • Male
  • Retrospective Studies
  • Substance Abuse, Intravenous (complications)
  • Survival Analysis
  • Treatment Outcome
  • Viral Load

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