Incidence and Predictors of Severe Liver Fibrosis in Human Immunodeficiency Virus–Infected Patients with Chronic Hepatitis C: A European Collaborative Study

Abstract

A study was performed in 10 European health care centers in which 914 patients coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) who had elevated serum alanine aminotransferase (ALT) levels underwent liver biopsy during the period of 1992 through 2002. Overall, the METAVIR liver fibrosis stage was F0 in 10% of patients, F1 in 33%, F2 in 22%, F3 in 22%, and F4 in 13%. Predictors of severe liver fibrosis (METAVIR stage, F3 or F4) in multivariate analysis were age of >35 years (odds ratio [OR], 2.95; 95% confidence interval [CI], 2.08-4.18), alcohol consumption of >50 g/day (OR, 1.61; 95% CI, 1.1-2.35), and CD4+ T cell count of <500 cells/mm3 (OR, 1.43; 95% CI, 1.03-1.98). Forty-six percent of patients aged >40 years had severe liver fibrosis, compared with 15% of subjects aged <30 years. The use of antiretroviral therapy was not associated with the severity of liver fibrosis. In summary, severe liver fibrosis is frequently found in HCV-HIV-coinfected patients with elevated serum ALT levels, and its severity increases significantly with age. The rate of complications due to end-stage liver disease will inevitably increase in this population, for whom anti-HCV therapy should be considered a priority.

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…It has been shown that the immune restoration associated with ART can limit the progression of HCV-associated disease so that even if they do not respond to HCV therapy there may be some longterm indirect benefit from ART [172,[197][198][199].…”

Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus

“…5 Most data on liver fibrosis progression in HIV and HCV coinfection come from cross-sectional studies that relied on a single liver biopsy. [6][7][8][9][10][11] In those studies, the date of HCV infection is usually estimated as the date of the first use of injection drugs. At HCV infection, it is assumed that liver fibrosis is absent.…”

“…These assumptions are probably one reason for the conflicting results of those studies, especially regarding the effect of ART on fibrosis progression. [6][7][8][9][10][11] Serial liver biopsy studies may have some advantages over single liver biopsy studies. Changes in fibrosis stage are observed between two dates, and fibrosis at the initial date is known.…”

HCV virological response during treatment of chronic hepatitis C is associated with liver histological Improvement in patients with HCV/HIV co-infection

“…Progression of hepatic fibrosis has been associated in HCV/HIV co-infected patients with some factors like gender (males), more advanced age when HCV infected, higher alcohol ingestion, lymphocytes CD 4 + cells < 500/mm 3 and HAART non-users [14,15]. In mono-infected patients, iron overload and hepatic steatosis may also be associated with a rapid fibrotic progression [16,17].…”