Advanced liver fibrosis in HIV/HCV-coinfected patients on antiretroviral therapy.

Abstract

HIV infection is believed to adversely affect the progression of hepatitis C virus (HCV)-related liver disease. However, information regarding HIV and HCV coinfection in the era of highly active antiretroviral therapy (HAART) is scarce. A cross-sectional study in 75 HCV/HIV-coinfected patients (most of them on HAART) and 75 HCV-monoinfected patients paired by age, sex, and date of liver biopsy analyzed the association of HIV infection with advanced liver fibrosis (Knodell fibrosis stages 3 + 4). The median CD4 cell count in HIV-coinfected patients was 546 cells/microl; 78.7% had an HIV-1 viral load <1000 copies/ml and 88% were on antiretroviral therapy. The percentage of patients harboring genotype 4 and with a higher HCV viral load was greater in the HIV-coinfected group. HCV/HIV-coinfected patients had more advanced liver fibrosis (Knodell fibrosis stages 3 + 4) than HCV-monoinfected patients (46.7% vs. 12%, p < 0.0001). In the univariate analysis, the factors associated with advanced liver disease were male sex (OR: 2.7, 95% CI: 1.05-7.1), history of injecting drug use (OR: 4.6, 95% CI: 2.0-10.2), HIV infection (OR: 6.4, 95% CI: 2.7-14.7), and previous exposure to therapy with protease inhibitors (OR: 3.0, 95% CI:1.4-6.3). In the multivariate analysis; only male sex (OR: 3.17, 95% CI: 1.152-8.773) and HIV infection (OR: 6.85, 95% CI: 2.93-16.005) were associated with advanced liver fibrosis. HIV infection is associated with advanced liver fibrosis. HIV/HCV-coinfected individuals on HAART are at risk of developing end-stage liver disease despite virological success and immunological reconstitution.

• Authors: Daniel Fuster, Ramon Planas, Robert Muga, Angel L Ballesteros, Justiniano Santos, Jordi Tor, Guillem Sirera, Helena Guardiola, Anna Salas, Eduard Cabré, Isabel Ojanguren, Eva Barluenga, Celestino Rey-Joly, Bonaventura Clotet, Cristina Tural
• Journal: AIDS research and human retroviruses (AIDS Res Hum Retroviruses) Vol. 20 Issue 12 Pg. 1293-7 (Dec 2004) ISSN: 0889-2229 [Print] United States
• PMID: 15650421 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents
• Protease Inhibitors

Topics

• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Antiretroviral Therapy, Highly Active
• Cross-Sectional Studies
• Disease Progression
• Fibrosis
• HIV Infections (complications, drug therapy, pathology)
• HIV-1
• Hepatitis C, Chronic (complications, drug therapy, pathology)
• Humans
• Liver Cirrhosis (etiology, pathology)
• Male
• Multivariate Analysis
• Protease Inhibitors (therapeutic use)