Analysis of the hepatic functional reserve, portal hypertension, and prognosis of patients with human immunodeficiency virus/hepatitis C virus coinfection through contaminated blood products in Japan.
BACKGROUND
As the survival of human immunodeficiency virus (HIV)-infected individuals has improved due to the widespread use of antiretroviral therapy, the mortality rate due to hepatitis C virus (HCV)-related liver disease has increased in HIV/HCV-coinfected patients.


OBJECTIVE
The aims of this study were to establish the appropriate therapeutic strategy for HIV/HCV-coinfected patients by evaluating the liver function, including the hepatic functional reserve and portal hypertension, and to investigate the prognosis of HIV/HCV-coinfected patients in Japan.


METHODS
In addition to regular liver function tests, the hepatic functional reserve of 41 patients with HIV/HCV coinfection was evaluated using the indocyanine green retention rate and liver galactosyl serum albumin-scintigraphy. The data for 146 patients with HIV/HCV coinfection through blood products were extracted from 4 major HIV centers in Japan. In addition to liver function tests, the platelet counts (PLT) were evaluated as a marker of portal hypertension.


RESULTS
In spite of the relatively preserved general liver function test results, approximately 40% of the HIV/HCV-coinfected patients had an impaired hepatic functional reserve. In addition, while the albumin and bilirubin levels were normal, the PLT was <150,000/μL in 17 patients. Compared with HCV mono-infected patients with a PLT <150,000/μL, the survival of HIV/HCV-coinfected patients was shorter (HCV, 5 years, 97%; 10 years, 86% and HIV/HCV, 5 years, 87%; 10 years, 73%; P < .05).


CONCLUSIONS
These results must be taken into account to establish an optimal therapeutic strategy, including the appropriate timing of liver transplantation in HIV/HCV-coinfected patients in Japan.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. Electronic address: sueguchi@nagasaki-u.ac.jp.
S
S
Eguchi
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
M
M
Takatsuki
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
A
A
Soyama
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
M
M
Hidaka
Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
K
K
Nakao
AIDS Medical Center; National Hospital Organization Osaka National Hospital, Fukuoka, Japan.
T
T
Shirasaka
Department of Immunology and Infectious Diseases, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
M
M
Yamamoto
Yokohama Municipal Citizen's Hospital, Tokyo, Japan.
N
N
Tachikawa
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
H
H
Gatanaga
Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Tokyo, Japan.
Y
Y
Kugiyama
Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Tokyo, Japan.
H
H
Yatsuhashi
Department of Gastroenterology and Hepatology, Shizuoka Hospital, University of Juntendo, Tokyo, Japan.
T
T
Ichida
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
N
N
Kokudo
D017848:Blood-Borne Pathogens; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology / Q000635:transmission; D006526:Hepatitis C / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007564:Japan; D008099:Liver / Q000503:physiopathology*; D011379:Prognosis; D065227:Transfusion Reaction