title: Antiretroviral therapy based on protease inhibitors as a protective factor against liver fibrosis progression in patients with chronic hepatitis C.
abstract: Cohort studies have shown that highly active antiretroviral therapy (HAART) can improve liver-related mortality in HIV/hepatitis C virus (HCV)-coinfected patients. A reduction in the accelerated liver fibrosis progression observed in HIV infection induced by HAART could explain these findings. A few studies have assessed the impact of HAART on liver fibrosis, but with contradictory results. Therefore, we evaluated the associations between the use of different antiretroviral drug classes and HAART combinations, and liver fibrosis in HIV-infected patients with chronic hepatitis C. Six hundred and eighty-three HIV/HCV-coinfected patients, who underwent a liver biopsy and who had not received anti-HCV treatment were included. Age at HCV infection < 23years (adjusted odds ratio [AOR] = 0.7, 95% confidence interval [95% CI] = 0.3-0.9, P = 0.05) and protease inhibitor (PI)-based HAART versus no use of HAART (AOR = 0.5, 95% CI = 0.3-0.9, P = 0.01) were negatively associated with advanced fibrosis (> or = F3). PI-based HAART versus no use of HAART (AOR = 0.4, 95% CI = 0.2-0.7, P = 0.001) was negatively associated with fibrosis progression rate > or = 0.2 units/year and independently of age at HCV infection and CD4+ T-cell counts. Fifteen (17%) patients treated only with PIs and zidovudine plus lamivudine showed > or = F3, compared with 65 (37%) patients without HAART (P = 0.001). Forty (31%) patients on PI and stavudine plus lamivudine showed > or = F3 (P = 0.3, when compared with patients with no HAART). The use of PI-based HAART in HIV/HCV-coinfected patients is associated with less severe fibrosis and slower progression of fibrosis. The nucleoside analogue backbone in a HAART regimen may influence this association.
authors.affiliation: Hospital Universitario de Valme, Seville, Spain. jmacias@cica.es
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: José A
authors.initials: JA
authors.lastname: Mira
authors.forename: Luis F
authors.initials: LF
authors.lastname: López-Cortés
authors.forename: Ignacio
authors.initials: I
authors.lastname: Santos
authors.forename: José A
authors.initials: JA
authors.lastname: Girón-González
authors.forename: Mercedes
authors.initials: M
authors.lastname: González-Serrano
authors.forename: Dolores
authors.initials: D
authors.lastname: Merino
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Quero
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.forename: Nicolás
authors.initials: N
authors.lastname: Merchante
authors.forename: Mónica
authors.initials: M
authors.lastname: Trastoy
authors.forename: Raquel
authors.initials: R
authors.lastname: Carrillo-Gómez
authors.forename: Ana
authors.initials: A
authors.lastname: Arizcorreta-Yarza
authors.forename: Jesús
authors.initials: J
authors.lastname: Gómez-Mateos
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D018450:Disease Progression; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D011480:Protease Inhibitors