title: More improvement than progression of liver fibrosis following antiretroviral therapy in a longitudinal cohort of HIV-infected patients with or without HBV and HCV co-infections.
abstract: We examined the effect of combination antiretroviral therapy (cART) on liver fibrosis among HIV-infected patients with or without hepatitis B (HBV) or C virus (HCV) co-infection. This was a retrospective cohort study of HIV-infected patients receiving cART during 2004-2016. Liver fibrosis was assessed using Fibrosis-4 (FIB-4) score with three classifications: Class 1, <1.45; Class 2, 1.45-3.25; Class 3, >3.25. Of 3900 participants, 68.6% were HIV mono-infected, 5.3% were HIV/HBV co-infected, 23.8% were HIV/HCV co-infected and 2.3% were HIV/HBV/HCV co-infected. Participants received follow-up treatment (median was 3.3 years). Improvement to a lower class was observed in Class 2 (52.6%) and Class 3 (74.2%), respectively. Progression to a higher class was observed in 12.8% and 5.0% in Class 1 and Class 2, respectively, and with a median time of 5.7 months. For improvement to lower classes, older age, male, Dai ethnicity, injection drug use, HCV co-infection and tenofovir for treatment were negative predictors, but in Class 3 of FIB-4 and time-updated increases in CD4 count from baseline were positive predictors. For progression to higher classes, older age, male, Jingpo ethnicity and HCV co-infection were positive predictors, while baseline CD4 count and in Class 2 of FIB-4 were negative predictors. Improvement to lower class linked with decreased mortality risk among patients in Class 3. Early cART initiation for HIV-infected patients with and without hepatitis co-infections may mitigate or slow down some of liver fibrosis, but special attention should be given to those who are older, male, co-infected with HCV.
authors.affiliation: Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China.
authors.forename: S
authors.initials: S
authors.lastname: Duan
authors.affiliation: Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China.
authors.forename: R
authors.initials: R
authors.lastname: Ye
authors.affiliation: Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China.
authors.forename: S
authors.initials: S
authors.lastname: Yao
authors.affiliation: Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Dehong Prefecture Hospital, Mangshi, Yunnan Province, China.
authors.forename: D
authors.initials: D
authors.lastname: Cao
authors.affiliation: Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, China.
authors.forename: L
authors.initials: L
authors.lastname: Lu
authors.affiliation: Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, China.
authors.forename: M
authors.initials: M
authors.lastname: Jia
authors.affiliation: National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: N
authors.initials: N
authors.lastname: He
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
keywords: 
  HBV
  ; 
  HCV
  ; 
  HIV
  ; antiretroviral therapy; liver fibrosis