Predictors of Chronic Hepatitis C Evolution in HIV Co-Infected Patients From Romania

Abstract

BackgroundDue to a recent alarming increase in the number of HIV-HCV co-infected patients in Romania.ObjectivesA cross sectional study was conducted to assess the baseline predictors of liver disease evolution.Patients and Methods83 HIV-HCV co-infected patients, untreated for HCV infection, were evaluated for viral replication, liver fibrosis (estimated by a noninvasive marker - FIB4), and plasma levels of IP-10 (interferon-gamma inducible protein 10) - a cytokine associated with an unfavorable outcome of HCV infection.ResultsThe median value for HCV viral load was high (6.3 log10 IU/mL), 98.8% of the patients were infected with HCV genotype 1. Although 53% of the patients received antiretroviral therapy (cART), only 31.8% of these achieved undetectable HIV levels. HCV viral load was significantly higher in patients with AIDS (6.4 vs. 6.1 log10IU/mL; P = 0.04), and in those naïve for cART (6.5 vs. 5.9 log10 IU/mL; P = 0.04). Severe fibrosis was directly correlated with immunosupression (56% vs. 17.4%, P = 0.03), HCV replication (6.1 vs. 4.9 log10IU/mL P = 0.008), and IP-10 median values (312 vs. 139 pg/ml, P=0.008). A serum IP-10 level higher than 400 pg/mL was significantly associated with FIB-4 median values (4.09 vs. 1.7, P = 0.004), HCV viral load (6.4 vs. 6.1 log10 IU/mL, P = 0.02) and ALT level (206.8 vs. 112.4 IU/L, P = 0.05).ConclusionsAn important part of the HIV-HCV co-infected patients had negative baseline predictors for the evolution of HCV infection; their therapeutical management must be conducted with special attention towards adherence and potential overlapping drug toxicities. High concentrations of plasma IP-10 are reliable markers for the severity of liver disease.

Hiv and HCV Coinfection: Prevalence, Associated Factors and Genotype Characterization in the Midwest Region of Brazil

“…Also, the present study showed a lack of statistical correlation between HCV genotypes and other modes of transmission, the serum HCV-RNA concentration, CD4 level and antiretroviral treatment. In contrast with studies conducted by other authors 42 , 45 , 52 , a significant relation was established between HCV genotypes and HIV viral load, where it was observed that patients infected with HCV genotype 1 presented with detectable viral load were significantly higher than those with genotype 3 ratio. The maintenance of viral load to undetectable levels is achieved by regular and continuous use of antiretroviral therapy 24 .…”

Molecular Mechanisms of Liver Fibrosis in HIV/HCV Coinfection

“…IP-10 is a CXC chemokine that binds to the CXCR3 immune system receptor present on a number of cells, including monocytes, NK cells and T cells. Various studies have identified elevated IP-10 levels as a negative prognostic indicator for both HCV infection and HIV infection, and it has also been proposed as a negative predictor of response to antiviral therapy in HCV mono-infected and HIV/HCV co-infected patients [ 108 , 109 ]. A high rate of inflammation, and subsequent activation of the endogenous IFN system, as well as significant levels of oxidative damage [ 110 ], have been proposed as mechanisms behind IP-10 elevation.…”

Are HIV, HBV and HCV Voluntary Counseling and Testing Programs Needed in Balkans?

“…The highest seroprevalence of HIV infection was observed in young persons (aged 20-39 years), whereas HBV and HCV infections were prevalent among elderly people (aged 50-59 years for HBV and more than 60 years for HCV). Our data suggest a high seroprevalence of unrecognized viral hepatitis infections in older people who were never screened and were exposed to potentially unsafe healthcare-associated parenteral practices before 1990-1995 ( 4 ). Although all the tested subjects received a 6-monthly retesting recommendation, retesting was performed for only 24% of the subjects; 0.2% of them were newly diagnosed with HIV (14 patients), 0.3% were diagnosed with HBV (19 patients), and 0.8% were diagnosed with HCV (52 patients).…”