Incidence and Predictors of Severe Liver Fibrosis in HIV-Infected Patients with Chronic Hepatitis C in Brazil

Abstract

The aim of this study was to examine the incidence and factors associated with the severity of liver fibrosis in 234 coinfected patients in Brazil. Patients were cared for in our clinic, from 1996 to 2004. Eligible patients were defined as patients with documented HIV and hepatitis C virus (HCV) infections and had previously undergone a liver biopsy. Patients with persistently normal alanine aminotransferase (ALT) were also included. The variables selected for study were age, gender, risk category, history of high alcohol consumption, CD4(+) T cell count, antiretroviral therapy usage, HCV genotype and duration of HCV infection. Stage of fibrosis was scored as follows: F0, no fibrosis; F1, portal fibrosis with no septa; F2, portal fibrosis with few septa; F3, bridging fibrosis with many septa; and F4, cirrhosis. The liver fibrosis stage was F3 in 39 (16.6%) and F4 in 20(8.5%) patients. Among patients with normal ALT, the liver fibrosis stage was F3-F4 in three patients (5.6%). Predictors of severe liver fibrosis (F3-F4) by multivariate analysis were age (older patients) and genotype 3 (genotype 1 = odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12 0.65). In summary, in the present study severe liver fibrosis was found in 25% of our patients and was associated with an age of more than 38 years at the time of liver biopsy as well as, HCV genotype 3. No differences were found with respect to CD4(+) T cell counts although patients with a CD4(+) T cell count greater than 50 were excluded.

Antiretroviral Therapy Reduces the Rate of Hepatic Decompensation Among HIV- and Hepatitis C Virus–Coinfected Veterans

“…ART could help reduce the risk of HCV-associated hepatic decompensation by controlling HIVmediated immune dysfunction and dysregulation through CD4 T-lymphocyte recovery. This mechanism is consistent with prior studies suggesting that CD4 count gain and suppression of HIV RNA are associated with reduced rates of advanced hepatic fibrosis, cirrhosis, hepatic decompensation, and/or death due to end-stage liver disease [6][7][8][9][10][11], although not with others [12][13][14]. In contrast, immune reconstitution due to ART could exacerbate host-mediated hepatic inflammation and chronic antiretroviral-associated hepatotoxicity and subsequently increase the risk of hepatic decompensation [11,[15][16][17].…”

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

“…These findings are consistent with previous studies that the prevalence of liver fibrosis is much higher in individuals co‐infected with HCV and HIV . The prevalence of cirrhosis in our HIV/HCV co‐infected population (24.1%) was higher than Europe (13%) and Brazil (8.5%) …”

Impact of HBV and HCV coinfection on CD4 cells among HIV-infected patients: a longitudinal retrospective study

“…In a study performed in Brazil, no statistically significant differences were observed in CD4/CD8 ratio between HCV genotypes 1 and 3 among HIV-infected patients [44]. However, patients infected with HCV genotype 3 showed faster liver fibrosis progression, often accompanied by liver steatosis, and HCV genotype 3 was related to prediction factors for severe hepatic fibrosis (F3-F4) [42,45]. Interestingly, patients with F3-F4 liver fibrosis demonstrated lower CD4/CD8 ratios compared with patients who had F0-F2 fibrosis [46].…”