title: Factors influencing liver fibrosis and necroinflammation in HIV/HCV coinfection and HCV monoinfection.
abstract: OBJECTIVE
  To define differences in liver histology between HIV/HCV coinfection and HCV monoinfection, and to investigate possible causative factors.
  
  
  METHODS
  Liver biopsies (LBs) from 440 consecutive HIV/HCV-coinfected patients (Group HIV/HCV) and 374 consecutive HCV-monoinfected patients (Group HCV) were evaluated for necroinflammation and fibrosis (Ishak) by a pathologist unaware of the clinical and laboratory data. All patients were HBsAg-negative, with no history of alcohol abuse and naïve to anti-HCV treatment. At LB, 78.4% of patients in Group HIV/HCV were on an antiretroviral regimen.
  
  
  RESULTS
  HIV/HCV-coinfected patients compared to the HCV-monoinfected patients were younger (p < 0.0001), more frequently males (p < 0.0001), and had HCV genotype 3 (p < 0.0001); they showed a good immunological condition (CD4+ cell count: 518 ± 166 cells/mm(3)). Patients in Group HIV/HCV more frequently showed a fibrosis score ≥4 (27.5 vs. 20.6%, p < 0.05) and a necroinflammation score ≥9 (25.9 vs. 13.4%; p < 0.0001). The prevalence of patients with fibrosis score ≥4 was significantly higher in older age classes in both Group HIV/HCV (p < 0.005) and Group HCV (p < 0.05). A necroinflammation score ≥9 was significantly higher in older age classes only in Group HIV/HCV (p < 0.05). A multivariate analysis for Group HIV/HCV revealed that the patient age and nadir of CD4+ cell count were independently associated to higher degrees of fibrosis, the patient age and antiretroviral treatment were associated to higher degrees of necroinflammation, and HCV genotype 3 was associated to higher degrees of steatosis.
  
  
  CONCLUSIONS
  The data suggest a need for early anti-HCV treatment in both HCV-monoinfected and HIV/HCV-coinfected patients.
authors.affiliation: Clinic of Infectious Diseases and Department of Pathology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy, sagnelli.caterina@libero.it.
authors.forename: C
authors.initials: C
authors.lastname: Sagnelli
authors.forename: C
authors.initials: C
authors.lastname: Uberti-Foppa
authors.forename: G
authors.initials: G
authors.lastname: Pasquale
authors.forename: S
authors.initials: S
authors.lastname: De Pascalis
authors.forename: N
authors.initials: N
authors.lastname: Coppola
authors.forename: L
authors.initials: L
authors.lastname: Albarello
authors.forename: C
authors.initials: C
authors.lastname: Doglioni
authors.forename: A
authors.initials: A
authors.lastname: Lazzarin
authors.forename: E
authors.initials: E
authors.lastname: Sagnelli
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D060085:Coinfection / Q000473:pathology* / Q000821:virology*; D005260:Female; D005838:Genotype; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000473:pathology* / Q000821:virology; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000473:pathology* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology / Q000821:virology; D015995:Prevalence