Transient elastography: a non-invasive tool for assessing liver fibrosis in HIV/HCV patients.
OBJECTIVE
To assess the prevalence of advanced liver fibrosis (ALF) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) and HIV/HCV patients using transient elastography, and to identify factors associated with ALF.


METHODS
Between September 2008 and October 2009, 71 HIV mono-infected, 57 HIV/HCV co-infected and 53 HCV mono-infected patients on regular follow-up at our Center were enrolled in this study. Alcohol intake, the main parameters of liver function, presence of HCV-RNA, HIV-RNA, duration of highly active anti-retroviral therapy (HAART) and CD4 cell count were recorded. ALF was defined as liver stiffness (LS) ≥ 9.5 kPa. To estimate liver fibrosis (LF) a further 2 reliable biochemical scores, aspartate aminotransferase platelet ratio index (APRI) and FIB-4, were also used.


RESULTS
LS values of co-infected patients were higher than in either HIV or HCV mono-infected patients (χ(2)(MH) = 4, P < 0.04). In fact, LS ≥ 9.5 was significantly higher in co-infected than in HIV and HCV mono-infected patients (χ(2) = 5, P < 0.03). Also APRI and the FIB-4 index showed more LF in co-infected than in HIV mono-infected patients (P < 0.0001), but not in HCV mono-infected patients. In HIV⁄HCV co-infected patients, the extent of LS was significantly associated with alcohol intake (P < 0.04) and lower CD4+ cell count (P < 0.02). In HCV patients, LS was correlated with alcohol intake (P < 0.001) and cholesterol levels (P < 0.03). Body mass index, diabetes, HCV- and HIV-viremia were not significantly correlated with LS. In addition, 20% of co-infected patients had virologically unsuccessful HAART; in 50% compliance was low, CD4+ levels were < 400 cells/mm(3) and LS was > 9.5 kPa. There was no significant correlation between extent of LF and HAART exposure or duration of HAART exposure, in particular with specific dideoxynucleoside analogues.


CONCLUSIONS
ALF was more frequent in co-infected than mono-infected patients. This result correlated with lower CD4 levels. Protective immunological effects of HAART on LF progression outweigh its hepatotoxic effects.
Department of Clinical Medicine and Emerging Pathologies, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy.
Valentina
V
Li Vecchi
Maurizio
M
Soresi
Claudia
C
Colomba
Giovanni
G
Mazzola
Pietro
P
Colletti
Maurizio
M
Mineo
Paola
P
Di Carlo
Emanuele
E
La Spada
Giovanni
G
Vizzini
Giuseppe
G
Montalto
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015897:Comorbidity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral
D012367:RNA, Viral; D001219:Aspartate Aminotransferases