title: Rapid progression to decompensated cirrhosis, liver transplant, and death in HIV-infected men after primary hepatitis C virus infection.
abstract: BACKGROUND
  We and others have shown that primary hepatitis C (HCV) infection in men infected with human immunodeficiency virus (HIV) causes early-onset liver fibrosis; however, little is known about the long-term natural history of the liver disease in these HIV-infected men.
  
  
  METHODS
  We followed a cohort of HIV-infected men with primary HCV infection in New York City.
  
  
  RESULTS
  Four men who were not cured after their primary HCV infection developed decompensated cirrhosis within 17 months to 6 years after primary HCV infection. Three died within 8 years of primary HCV infection, and 1 survived after liver transplant done 2 years after primary HCV infection. Three of the 4 men had AIDS at the time of primary HCV infection, and the most rapid progression occurred in the 2 men with the lowest CD4 counts at the time of HCV infection. Liver histopathology was most consistent with HCV-induced damage even though some had exposures to other potential hepatotoxins.
  
  
  CONCLUSIONS
  Primary HCV infection resulted in decompensated cirrhosis and death within 2-8 years in 4 HIV-infected men. The rapid onset of fibrosis due to primary HCV infection in HIV-infected men cannot therefore be considered benign. The rate of continued progression to liver failure may be proportional to the degree of underlying immunocompromise caused by HIV infection. More research is needed to better define the mechanisms behind accelerated liver damage.
authors.affiliation: Divisions of Infectious Diseases, Mount Sinai School of Medicine, New York, NY, USA. daniel.fierer@mssm.edu
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Fierer
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Dieterich
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Fiel
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Branch
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Marks
authors.forename: Dahlene N
authors.initials: DN
authors.lastname: Fusco
authors.forename: Ricky
authors.initials: R
authors.lastname: Hsu
authors.forename: Davey M
authors.initials: DM
authors.lastname: Smith
authors.forename: Joshua
authors.initials: J
authors.lastname: Fierer
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D017809:Fatal Outcome; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006526:Hepatitis C / Q000150:complications* / Q000628:therapy; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D017093:Liver Failure / Q000150:complications* / Q000175:diagnosis; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009519:New York City; D013997:Time Factors