title: Advanced liver fibrosis by transient elastography, fibrosis 4, and alanine aminotransferase/platelet ratio index among Asian hepatitis C with and without human immunodeficiency virus infection: role of vitamin D levels.
abstract: OBJECTIVE
  Vitamin D insufficiency plays an important role in liver fibrosis in hepatitis C virus (HCV)-infected patients. We assessed liver fibrosis by transient elastography and 25 hydroxy vitamin D [25(OH)D] status in HCV-infected patients, with (HIV/HCV) or without HIV co-infection (HCV) from Thailand.
  
  
  METHODS
  Fibrosis stage was defined as mild (< 7.1 kPa); moderate (7.2-9.4 kPa); severe (9.5-14 kPa), and cirrhosis (> 14 kPa). Hypovitaminosis D was defined as 25(OH)D < 30 ng/mL. Logistic regression analyses were used to assess predictors for significant fibrosis. Serum 25(OH) D levels, HCV genotypes (GT), interleukin-28B (IL28B) and HCV-RNA were assessed.
  
  
  RESULTS
  A total of 331 HCV and 130 HIV/HCV patients were enrolled (70% male, 35% people who inject drugs [PWIDs]). HCV GT distribution was as follows: GT3 47%, GT1 34%, GT6 17%. IL-28B CC genotype (rs12979860) were found in 88% of HIV/HCV and 85% of HCV. In HCV, liver fibrosis was mild in 56.5%; moderate in 18.4%; severe in 12.4%; and cirrhosis in 12.7%. In HIV/HCV, these figures were 30.6%, 27.8%, 17.6%, and 24.1%, respectively. Patients with significant fibrosis were more often male, older, with HIV infection, hypovitaminosis D, and less likely to be infected with GT6. Factors associated with significant fibrosis by multivariate analysis were HIV infection (adjusted odd ratio [95% confidential interval]: 2.67, 1.20-5.93), P = 0.016, Fib-4 score > 1.45 (6.30, 2.70-14.74), P < 0.001, and hypovitaminosis D (2.48, 1.09-5.67), P = 0.031. GT 6 was less likely to have advanced liver fibrosis (0.17, 0.05-0.65), P = 0.01.
  
  
  CONCLUSIONS
  HIV infection, Fib-4 score > 1.45, and hypovitaminosis D are strong and independent predictors for the presence of advanced fibrosis in our HCV-infected patients. These data highlight the urgent need of HCV treatment and vitamin D supplement in resource-limited settings.
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Center, Bangkok, Thailand; Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
authors.forename: Salyavit
authors.initials: S
authors.lastname: Jitmitraparp
authors.forename: Pisit
authors.initials: P
authors.lastname: Tangkijvanich
authors.forename: Reshmie A
authors.initials: RA
authors.lastname: Ramautarsing
authors.forename: Tanakorn
authors.initials: T
authors.lastname: Apornpong
authors.forename: Supunee
authors.initials: S
authors.lastname: Jirajariyavej
authors.forename: Opass
authors.initials: O
authors.lastname: Putcharoen
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.forename: Srunthron
authors.initials: S
authors.lastname: Akkarathamrongsin
authors.forename: Yong
authors.initials: Y
authors.lastname: Poovorawan
authors.forename: Gail V
authors.initials: GV
authors.lastname: Matthews
authors.forename: Joep M A
authors.initials: JM
authors.lastname: Lange
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D060085:Coinfection; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013785:Thailand; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications* / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000410:Alanine Transaminase
keywords: APRI; Fib-4; HIV/hepatitis C co-infection; Thailand; genotype 3; genotype 6; hepatitis C; liver fibrosis; vitamin D.