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.