title: Hepatic Fibrosis Progression in HIV-Hepatitis C Virus Co-Infection--The Effect of Sex on Risk of Significant Fibrosis Measured by Aspartate-to-Platelet Ratio Index.
abstract: BACKGROUND
  In Hepatitis C virus (HCV) mono-infection, male sex is associated with faster liver fibrosis progression but the effects of sex have not been well studied in HIV-HCV co-infected patients. We examined the influence of sex on progression to significant liver fibrosis in HIV-HCV co-infected adults receiving antiretroviral therapy (ART) using the aspartate aminotransferase-to-platelet ratio index (APRI) as a surrogate biomarker of liver fibrosis.
  
  
  METHODS
  We evaluated 308 HIV infected, HCV RNA positive participants of a Canadian multicentre prospective cohort receiving antiretrovirals and without significant liver fibrosis or end-stage liver disease at baseline. We used multivariate discrete-time proportional hazards models to assess the effect of sex on time to significant fibrosis (APRI≥1.5) adjusting for baseline age, alcohol use, cigarette smoking, HCV duration, and APRI and time-updated CD4 count and HIV RNA.
  
  
  RESULTS
  Overall, 55 (18%) participants developed an APRI ≥ 1.5 over 544 person-years of at-risk follow-up time; 18 (21%) women (incidence rate (IR)=14.0/100 PY; 7.5-20.4) and 37 (17%) men (IR=8.9/100 PY; 6.0-11.8). Women had more favourable profiles with respect to traditional risk factors for liver disease progression (younger, shorter duration of HCV infection and less alcohol use). Despite this, female sex was associated with a greater than two-fold increased risk of fibrosis progression (adjusted hazard rate (HR) =2.23; 1.22-4.08).
  
  
  CONCLUSIONS
  HIV-HCV co-infected women receiving antiretroviral therapy were at significantly greater risk of progressing to liver fibrosis as measured by APRI compared with men. Enhanced efforts to engage and treat co-infected women for HCV are needed.
authors.affiliation: Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Rollet-Kurhajec
authors.affiliation: Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada.
authors.forename: Erica E M
authors.initials: EE
authors.lastname: Moodie
authors.affiliation: University Health Network, Toronto, Canada; CIHR Canadian HIV Trials Network, Vancouver, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: CIHR Canadian HIV Trials Network, Vancouver, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Oak Tree Clinic, BC Women's Hospital, Divisions of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Neora
authors.initials: N
authors.lastname: Pick
authors.affiliation: Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada; CIHR Canadian HIV Trials Network, Vancouver, Canada.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001219:Aspartate Aminotransferases; D001224:Aspartic Acid / Q000378:metabolism*; D015415:Biomarkers; D001792:Blood Platelets / Q000378:metabolism*; D002170:Canada; D060085:Coinfection; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D001224:Aspartic Acid; D001219:Aspartate Aminotransferases