Progression of liver fibrosis following acute hepatitis C virus infection in HIV-positive MSM.

Abstract

BACKGROUND:

Whether continued, accelerated liver fibrosis progression occurs following acute hepatitis C virus infection (AHCVI) in HIV-positive MSM is unknown.

DESIGN AND METHODS:

HIV-positive MSM from the AIDS Therapy Evaluation in the Netherlands and MSM Observational Study for Acute Infection with Hepatitis C-cohorts with primary AHCVI and at least one fibrosis-4 (FIB-4) measurement less than 2 years before and 1 year after estimated AHCVI were included. Mixed-effect linear models were used to evaluate (time-updated) determinants of FIB-4 levels over time. Determinants of transitioning to and from FIB-4 ≤ 1.45 and > 1.45 were examined using multistate Markov models.

RESULTS:

Of 313 MSM, median FIB-4 measurements per individual was 12 (interquartile range  = 8-18) and median follow-up following AHCVI was 3.5 years (interquartile range = 1.9-5.6). FIB-4 measurements averaged at 1.00 [95% confidence interval (CI) = 0.95-1.05] before AHCVI, 1.31 (95% CI = 1.25-1.38) during the first year of AHCVI and 1.10 (95% CI = 1.05-1.15) more than 1 year after AHCVI. Mean FIB-4 more than 1 year after AHCVI was higher for chronically infected patients compared with those successfully treated (P = 0.007). Overall FIB-4 scores were significantly higher with older age, lower CD4 cell count, longer duration from HIV-diagnosis or AHCVI, and nonresponse to HCV-treatment. At the end of follow-up, 60 (19.2%) and eight MSM (2.6%) had FIB-4 between 1.45-3.25 and ≥ 3.25, respectively. Older age, lower CD4 cell count and detectable HIV-RNA were significantly associated with higher rates of progression to FIB-4 > 1.45, whereas older age, longer duration from HIV-diagnosis and nonresponse to HCV-treatment were significantly associated with lower rates of regression to FIB-4 ≤ 1.45.

CONCLUSION:

In this population of HIV-positive MSM, FIB-4 scores were higher during the first year of AHCVI, but FIB-4 ≥ 3.25 was uncommon by the end of follow-up. Well controlled HIV-infection appears to attenuate FIB-4 progression.

• Authors: Astrid M Newsum, Katherine W Kooij, Anders Boyd, Colette Smit, Ferdinand W N M Wit, Jan T M van der Meer, Maria Prins, Peter Reiss, Marc van der Valk, MOSAIC study group, ATHENA observational HIV cohort and NVHB-SHM hepatitis working group
• Journal: AIDS (London, England) (AIDS) Vol. 33 Issue 5 Pg. 833-844 (04 01 2019) ISSN: 1473-5571 [Electronic] England
• PMID: 30649050 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Coinfection (virology)
• Disease Progression
• HIV Infections (physiopathology)
• Hepatitis C (complications, pathology)
• Homosexuality, Male
• Humans
• Liver Cirrhosis (etiology, pathology, virology)
• Male
• Markov Chains
• Netherlands (epidemiology)
• Retrospective Studies