Do type and duration of antiretroviral therapy attenuate liver fibrosis in HIV-hepatitis C virus-coinfected patients?
BACKGROUND
This study aimed to determine whether type and duration of therapy for human immunodeficiency virus (HIV) infection attenuates liver fibrosis in patients with HIV and hepatitis C virus (HCV) coinfection.


METHODS
Patients with HCV monoinfection (group 1) and HIV-HCV coinfection were retrospectively selected; the latter patients were classified into the following 3 groups: group 2, patients who received no therapy or only nucleoside reverse-transcriptase inhibitors (NRTIs); group 3, those who received highly active antiretroviral therapy (HAART); and group 4, those who initially received NRTIs followed by HAART. Fibrosis stage (scale, 0-6) and necroinflammatory score (scale, 0-18) were assessed according to the Ishak system. Data are presented as mean +/- standard deviation.


RESULTS
Three hundred eighty-one patients (296 HCV-monoinfected patients and 85 HIV-HCV-coinfected patients) were recruited. The durations of HIV therapy before liver biopsy was performed for groups 2, 3, and 4 were 3.8 +/- 2.8, 3.3 +/- 1.8, and 6.6 +/- 2.2 years. The time from HIV diagnosis to HAART initiation was shorter for group 3 than for group 4 (9.1 +/- 7.3 vs. 34.1 +/- 13.1 months; P < .0001). Groups 1 and 3 had similar fibrosis stages (3.1 +/- 2 vs. 3.4 +/- 2.4), rates of fibrosis progression (0.13 +/- 0.09 vs. 0.16 +/- 0.11 per year), and necroinflammatory scores (6.1 +/- 1.8 vs. 6.1 +/- 2.0). Groups 2 and 4 had significantly more-advanced liver disease, as determined by fibrosis stage (4.6 +/- 1.8 vs. 4.3 +/- 2.0; P < .0009), rate of fibrosis progression (0.24 +/- 0.11 vs. 0.20 +/- 0.10 per year; P < .0001), and prevalence of cirrhosis (68% vs. 55%; P < .006), compared with group 1.


CONCLUSIONS
HIC-HCV-coinfected subjects who receive HAART as their sole form of therapy have liver histology findings comparable to those for HCV-monoinfected patients. A similar degree of benefit is not observed for HIV-HCV-coinfected patients who receive no therapy, NRTIs, or HAART after NRTIs, despite having a longer duration of therapy.
Verma
Sumita
S
Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA 90033, USA. sumitaverma6@hotmail.com
Wang
Chun-Hsiang
CH
Govindarajan
Sugantha
S
Kanel
Gary
G
Squires
Kathleen
K
Bonacini
Maurizio
M
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio
D019380:Anti-HIV Agents