Advanced liver fibrosis in HIV/HCV-coinfected patients on antiretroviral therapy.
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.
Fuster
Daniel
D
HIV Clinical Unit Department, University Hospital Germans Trias i Pujol, Universitat Autónoma de Barcelona (UAB), 08916 Badalona, Barcelona, Spain.
Planas
Ramon
R
Muga
Robert
R
Ballesteros
Angel L
AL
Santos
Justiniano
J
Tor
Jordi
J
Sirera
Guillem
G
Guardiola
Helena
H
Salas
Anna
A
Cabré
Eduard
E
Ojanguren
Isabel
I
Barluenga
Eva
E
Rey-Joly
Celestino
C
Clotet
Bonaventura
B
Tural
Cristina
C
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005355:Fibrosis; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D015497:HIV-1; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D011480:Protease Inhibitors / Q000627:therapeutic use
D019380:Anti-HIV Agents; D011480:Protease Inhibitors