Liver fibrosis in HIV-positive patients with hepatitis C virus: role of persistently normal alanine aminotransferase levels.
BACKGROUND
Liver fibrosis requiring treatment in HIV/hepatitis C virus (HCV)-coinfected patients with persistently normal alanine aminotransferase (ALT) values (PNAL) is currently not well defined; in this study clinical and histologic features of PNAL were compared with those of subjects with elevated ALT (EAL).


METHODS
A total of 326 liver biopsies of HIV/HCV-coinfected patients, performed from 1997-2003, were retrospectively identified. Subjects with at least 3 consecutive normal ALT determinations during a prebiopsy follow-up of 12 months were grouped as PNAL (24 patients) and compared with EAL subjects (302 patients). Liver biopsy was classified with the modified Ishak score.


RESULTS
Age, HCV viral load, and genotype, CD4 T-cell count, and antiretroviral drugs did not show a statistical difference between the 2 groups. Statistical significance was found when comparing mean grading (1.4 +/- 1.8 vs. 7.2 +/- 2.6, P < 0.0001) and staging (1.4 +/- 1.79 vs. 2.5 +/- 1.7, P < 0.0003) between PNAL and EAL subjects. The proportion of PNAL patients fulfilling histologic criteria for anti-HCV treatment (25% with stage 2-6) was also significantly different from EAL subjects (69%; P = 0.0001). At multivariate analysis, only age, CD4 count (>500 vs. < or =500 cells/mL), and patient's group (EAL vs. PNAL) were found to be independently associated with a fibrosis score of > or =2.


CONCLUSIONS
Liver fibrosis requiring treatment was found in 25% of HIV/HCV-coinfected subjects with PNAL values.
Uberti-Foppa
Caterina
C
Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. uberti.caterina@hsr.it
De Bona
Anna
A
Galli
Laura
L
Sitia
Giovanni
G
Gallotta
Giulia
G
Sagnelli
Caterina
C
Paties
Carlo
C
Lazzarin
Adriano
A
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D005260:Female; D006679:HIV Seropositivity / Q000097:blood / Q000150:complications* / Q000201:enzymology; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000201:enzymology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000201:enzymology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000235:genetics / Q000302:isolation & purification; D012016:Reference Values; D012189:Retrospective Studies; D019562:Viral Load
D015415:Biomarkers; D012367:RNA, Viral; D000410:Alanine Transaminase