Fibrosis progression in paired liver biopsies from HIV/HCV co-infected patients.
BACKGROUND
Chronic hepatitis C is more aggressive during HIV infection. Available data about risk factors of liver fibrosis in HIV/HCV co-infected patients derive from studies based on a single liver biopsy.


OBJECTIVE
To evaluate the risk factors of liver fibrosis progression (LFP) and to investigate the role of antiretroviral therapy (ARV) in HIV/HCV patients who underwent paired liver biopsy.


METHODS
We retrospectively studied 58 patients followed at two Infectious Diseases Departments in Northern Italy during the period 1988-2005. All specimens were double-blinded and centrally examined by two pathologists. LFP was defined when an increase of at least one stage occurred in the second biopsy, according to the Ishak-Knodell classification.


RESULTS
In a univariate analysis, serum levels of alanine aminotransferase (ALT) > 150 IU/L at the first biopsy (P = 0.02), and a > 20% decrease in CD4+ cell count between the two biopsies (P = 0.007), were significantly associated with LFP. In multivariate analysis, a > 20% decrease in CD4+ cell count remained independently associated to LFP (Odds Ratio, 3.99; 95% confidence interval, 1.25-12.76; P < 0.02). Analysis of life survival curves confirmed the correlation between CD4+ cell count and LFP.


CONCLUSIONS
Our findings highlight that in HIV/HCV coinfected patients, an effective antiretroviral therapy that assures a good immune-virological profile contributes to reducing the risk of LFP.
Department of Infectious Diseases, L. Sacco Hospital, Milan, Italy.
Monica
M
Schiavini
Elena
E
Angeli
Annalisa
A
Mainini
Caterina
C
Uberti-Foppa
Pietro
P
Zerbi
Caterina
C
Sagnelli
Antonietta
A
Cargnel
Gianluca
G
Vago
Pier Giorgio
PG
Duca
Riccardo
R
Giorgi
Giuliano
G
Rizzardini
Guido
G
Gubertini