title: Progression of Liver Fibrosis and Modern Combination Antiretroviral Therapy Regimens in HIV-Hepatitis C-Coinfected Persons.
abstract: BACKGROUND
  Liver diseases progress faster in human immunodeficiency virus (HIV)-hepatitis C virus (HCV)-coinfected persons than HIV-monoinfected persons. The aim of this study was to compare rates of liver fibrosis progression (measured by the aspartate-to-platelet ratio index [APRI]) among HIV-HCV-coinfected users of modern protease inhibitor (PI)- and nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens with a backbone of tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC).
  
  
  METHODS
  Data from a Canadian multicenter cohort study were analyzed, including 315 HCV polymerase chain reaction-positive persons who initiated antiretroviral therapy with a PI or NNRTI and a backbone containing either TDF/FTC or ABC/3TC. Multivariate linear regression analyses with generalized estimating equations were performed after propensity score matching to balance covariates across classes of anchor agent.
  
  
  RESULTS
  A backbone of TDF/FTC was received by 67% of PI users and 69% of NNRTI users. Both PI and NNRTI use was associated with increases in APRI over time when paired with a backbone of ABC/3TC: 16% per 5 years (95% confidence interval [CI], 4%, 29%) and 11% per 5 years (95% CI, 2%, 20%), respectively. With TDF/FTC use, no clear association was found among PI users (8% per 5 years, 95% CI, -3%, 19%) or NNRTI users (3% per 5 years, 95% CI, -7%, 12%).
  
  
  CONCLUSIONS
  Liver fibrosis progression was more influenced by the backbone than by the class of anchor agent in HIV-HCV-coinfected persons. Only ABC/3TC-containing regimens were associated with an increase of APRI score over time, regardless of the class of anchor agent used.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Laurence
authors.initials: L
authors.lastname: Brunet
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Erica E M
authors.initials: EEM
authors.lastname: Moodie
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland.
authors.forename: Jim
authors.initials: J
authors.lastname: Young
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cox
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS.|Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hull
authors.affiliation: Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.|The Ottawa Hospital-General Campus.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.|University Health Network, University of Toronto, Ontario.
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: Centre Hospitalier de l'Université de Montréal-Notre-Dame, Quebec.
authors.forename: Valérie
authors.initials: V
authors.lastname: Martel-Laferrière
authors.affiliation: Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.|Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Ontario.
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.affiliation: Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia.|Chronic Viral Illness Service, Montreal Chest Institute, McGill University Health Centre, Quebec, Canada.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Jeff
authors.initials: J
authors.lastname: Cohen
authors.forename: Brian
authors.initials: B
authors.lastname: Conway
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Joseph
authors.initials: J
authors.lastname: Cox
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Shariq
authors.initials: S
authors.lastname: Haider
authors.forename: Aida
authors.initials: A
authors.lastname: Sadr
authors.forename: Lynn
authors.initials: L
authors.lastname: Johnston
authors.forename: Mark
authors.initials: M
authors.lastname: Hull
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Erica
authors.initials: E
authors.lastname: Moodie
authors.forename: Neora
authors.initials: N
authors.lastname: Pick
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.forename: Danielle
authors.initials: D
authors.lastname: Rouleau
authors.forename: Roger
authors.initials: R
authors.lastname: Sandre
authors.forename: Joseph Mark
authors.initials: JM
authors.lastname: Tyndall
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Vachon
authors.forename: Steve
authors.initials: S
authors.lastname: Sanche
authors.forename: Stewart
authors.initials: S
authors.lastname: Skinner
authors.forename: David
authors.initials: D
authors.lastname: Wong
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D002170:Canada; D015331:Cohort Studies; D060085:Coinfection / Q000473:pathology; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D001219:Aspartate Aminotransferases
keywords: APRI; HIV; combination antiretroviral therapy; hepatitis C; liver fibrosis