Liver fibrosis on account of chronic hepatitis C is more severe in HIV-positive than HIV-negative patients despite antiretroviral therapy.
The recent availability of non-invasive tools to measure liver fibrosis has allowed examination of its extent and determination of predictors in all patients with chronic hepatitis C virus (HCV) infection. On the other hand, most information on hepatic fibrosis in HCV/human immunodeficiency virus (HIV)-coinfected patients has been derived from liver biopsies taken before highly active antiretroviral therapy (HAART) was widely available. All consecutive HCV patients with elevated aminotransferases seen during the last 3 years were evaluated and liver fibrosis measured using transient elastography (FibroScan) and biochemical indexes. Patients were split according to their HIV serostatus. A total of 656 (69.6%) HCV-monoinfected and 287 (30.4%) HIV/HCV-coinfected patients were assessed. Mean CD4 count of coinfected patients was 493 cells/muL and 88% were under HAART (mean time, 4.2 +/- 2.4 years). Advanced liver fibrosis or cirrhosis was recognized in 39% of the coinfected and 18% of the monoinfected patients (P < 0.005). A good correlation was found between FibroScan) and biochemical indexes [AST to platelet ratio index (r = 0.405, P < 0.0001), FIB-4 (r = 0.393, P < 0.0001) and Forns (r = 0.407, P < 0.0001)], regardless of the HIV status. In the multivariate analysis, age >45 years, body mass index (BMI) >25 kg/m(2), and HIV infection were independently associated with advanced liver fibrosis or cirrhosis. HIV/HCV-coinfected patients have more advanced liver fibrosis than HCV-monoinfected patients despite the immunologic benefit of HAART.
de Lédinghen
V
V
Centre d'Investigation de la Fibrose Hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France. victor.deledinghen@chu-bordeaux.fr
Barreiro
P
P
Foucher
J
J
Labarga
P
P
Castéra
L
L
Vispo
M E
ME
Bernard
P-H
PH
Martin-Carbonero
L
L
Neau
D
D
García-Gascó
P
P
Merrouche
W
W
Soriano
V
V
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis