HIV mono-infection is associated with FIB-4 - A noninvasive index of liver fibrosis - in women.
BACKGROUND
FIB-4 represents a noninvasive, composite index that is a validated measure of hepatic fibrosis, which is an important indicator of liver disease. To date, there are limited data regarding hepatic fibrosis in women.


METHODS
FIB-4 was evaluated in a cohort of 1227 women, and associations were evaluated in univariate and multivariate regression models among 4 groups of subjects classified by their human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection status.


RESULTS
The median FIB-4 scores were 0.60 in HIV-/HCV- women, 0.83 in HIV-/HCV+ women, 0.86 in HIV+/HCV- women, and 1.30 in HIV+/HCV+ women. In the HIV/HCV co-infected group, multivariate analysis showed that CD4(+) cell count and albumin level were negatively associated with FIB-4 (P <.0001), whereas antiretroviral therapy (ART) was positively associated with FIB-4 score (P =.0008). For the HIV mono-infected group, multivariate analysis showed that CD4(+) cell count (P <.0001) and albumin level (P =.0019) were negatively correlated with FIB-4 score, ART was positively associated with FIB-4 score (P =.0008), and plasma HIV RNA level was marginally associated with FIB-4 score (P =.080). In 72 HIV mono-infected women who were also hepatitis B surface antigen negative, ART naive, and reported no recent alcohol intake, plasma HIV RNA level was associated with increased FIB-4 score (P =.030).


CONCLUSIONS
HIV RNA level was associated with increased FIB-4 score in the absence of hepatitis B, hepatitis C, ART, or alcohol use, suggesting a potential relationship between HIV infection and hepatic fibrosis in vivo. A better understanding of the various demographic and virologic variables that contribute to hepatic fibrosis may lead to more effective treatment of HIV infection and its co-morbid conditions.
Division of Digestive Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. ason.blackard@uc.edu
Jason T
JT
Blackard
Jeffrey A
JA
Welge
Lynn E
LE
Taylor
Kenneth H
KH
Mayer
Robert S
RS
Klein
David D
DD
Celentano
Denise J
DJ
Jamieson
Lytt
L
Gardner
Kenneth E
KE
Sherman
D015415:Biomarkers / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus / Q000302:isolation & purification; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology*; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
D015415:Biomarkers; D012367:RNA, Viral
N Engl J Med. 2009 Apr 30;360(18):1815-26
19339714
J Viral Hepat. 2008 Jun;15(6):427-33
18221303
Hepatology. 2007 Jul;46(1):32-6
17567829
Hepatology. 2009 Feb;49(2):436-42
19085967
Dig Dis Sci. 2010 Sep;55(9):2636-43
19960253
Clin Infect Dis. 2003 Feb 1;36(3):363-7
12539079
J Biol Chem. 2003 Sep 12;278(37):35755-66
12824191
Virol J. 2009 Oct 30;6:181
19878552
AIDS. 1992 Jan;6(1):65-70
1543567
J Infect Dis. 2003 Oct 15;188(8):1192-204
14551890
Wien Klin Wochenschr. 2009;121(23-24):732-44
20047110
Clin Gastroenterol Hepatol. 2009 Apr;7(4):471-80, 480.e1-2
19268724
J Hepatol. 1993 Sep;19(2):252-8
8301058
Eur J Med Res. 2010 Apr 8;15(4):139-44
20554494
Dig Dis Sci. 2008 May;53(5):1375-82
17939038
J Infect Dis. 2003 Nov 15;188(10):1455-60
14624370
Res Virol. 1990 Mar-Apr;141(2):153-9
1971728
J Infect Dis. 2001 Mar 15;183(6):973-6
11237816
Am J Epidemiol. 1997 Sep 15;146(6):459-69
9290506
Clin Infect Dis. 2010 Feb 15;50(4):502-11
20085465
J Viral Hepat. 2008 May;15(5):323-30
18208497
J Hepatol. 2006 Jan;44(1):47-55
16182404
HIV Med. 2009 Mar;10(3):133-42
19207596
AIDS. 1992 Oct;6(10):1127-31
1466843
Clin Gastroenterol Hepatol. 2004 May;2(5):432-9
15118983
J Virol. 2010 Jun;84(12):5860-7
20357083
Curr HIV Res. 2008 Sep;6(5):411-8
18855651
J Infect Dis. 2003 May 1;187(9):1388-96
12717619
Lancet. 1994 Feb 12;343(8894):383-5
7905551
AIDS Patient Care STDS. 1998 May;12(5):347-57
11361970
Clin Infect Dis. 2001 Feb 1;32(3):492-7
11170959
J Virol. 1990 Jun;64(6):2553-9
2159530
AIDS. 2008 Sep 12;22(14):1749-57
18753859
J Acquir Immune Defic Syndr. 2003 Aug 15;33(5):614-24
12902807
Am J Med. 1992 Apr;92(4):404-11
1558086
N Engl J Med. 1998 Jul 2;339(1):33-9
9647878
Hepatology. 2003 Aug;38(2):518-26
12883497
Hepatology. 2006 Jun;43(6):1317-25
16729309
Adv Clin Chem. 2008;46:131-60
19004189
Gut. 2010 Apr;59(4):513-20
19736361