The Clinical Spectrum of Hepatitis C Virus in HIV Coinfection

Sterling, Richard K.; Contos, Melissa J.; Sanyal, Arun J.; Luketic, Velimir A.; Stravitz, R. Todd; Wilson, Mary S.; Mills, A. Scott; Shiffman, Mitchell L.

doi:10.1097/00126334-200301010-00005

Cited by 51 publications

(34 citation statements)

References 59 publications

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“…7,47,48 Few studies have addressed noninvasive markers of hepatic fibrosis in HIV/HCV coinfected patients. 37 Myers et al 36 studied the use of an index incorporating age, sex, ␣2 macroglobulin, apolipoprotein A1, haptoglobin, bilirubin, and ␥-glutamyltranspeptidase in 130 coinfected patients from a single French center.…”

Section: Discussionmentioning

confidence: 99%

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Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection

et al. 2006

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Liver biopsy remains the gold standard in the assessment of severity of liver disease. Noninvasive tests have gained popularity to predict histology in view of the associated risks of biopsy. However, many models include tests not readily available, and there are limited data from patients with HIV/hepatitis C virus (HCV) coinfection. We aimed to develop a model using routine tests to predict liver fibrosis in patients with HIV/HCV coinfection. A retrospective analysis of liver histology was performed in 832 patients. Liver fibrosis was assessed via Ishak score; patients were categorized as 0-1, 2-3, or 4-6 and were randomly assigned to training (n ‫؍‬ 555) or validation (n ‫؍‬ 277) sets. Multivariate logistic regression analysis revealed that platelet count (

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Section: Discussionmentioning

confidence: 99%

“…However, diagnosis of cirrhosis in these patients can be made clinically and often does not require liver biopsy. We also recognize that a significant proportion of coinfected patients may have normal ALT levels, 47 which was an exclusion criterion for entry into APRICOT. Therefore, our model may not apply to these populations.…”

Section: Discussionmentioning

confidence: 99%

Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection

et al. 2006

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“…16,18,19 Although there could be several explanations for this result, the lack of selection bias in studying patients in an HIV clinic (rather than a liver clinic) probably contributes, because many of these individuals had not been referred for management of hepatitis C. However, the remarkable range of severity of liver fibrosis among the patients is also notable. Although minimal liver disease was detected in a significant proportion of patients, more than 25% already had advanced disease with histological evidence of bridging fibrosis or cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

The effect of antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection

Mehta

Thomas

Torbenson³

et al. 2005

Hepatology

102

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In the era of antiretroviral therapy (ART), liver disease has emerged as an important cause of death among persons with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection. The objective of this study was to estimate the burden of liver disease and evaluate determinants of liver fibrosis and necroinflammatory activity among HIV/HCV coinfected patients receiving ART. We studied 112 randomly selected and 98 referred HCVinfected patients undergoing care in the Johns Hopkins University HIV clinic. Liver disease was characterized clinically and histologically. Of the 210 individuals studied-64% of whom had received ART within 2 years of liver disease assessment-33% had no fibrosis (F0), and 26% had bridging fibrosis or cirrhosis (>F3). The median necroinflammatory activity score was 3 (range, 0-9 of 18). ART was not associated with fibrosis; however, significantly less hepatic necroinflammatory activity was observed among persons who had received highly active antiretroviral therapy longer (P ‫؍‬ .02) and more effectively (defined by HIV RNA suppression; P < .01). Twelve percent of individuals had previous ARTassociated liver enzyme elevations (grades 3-4), but liver fibrosis was not more severe if the liver enzyme elevation resolved. On the other hand, liver fibrosis was more severe in persons with persistent liver enzyme elevations (grades 1-4). In conclusion, despite widespread exposure to ART and documented instances of ART-related hepatitis, we found no evidence that ART caused serious histological liver disease. Recognition of bridging fibrosis and cirrhosis in some but not most patients underscores the importance of identifying and treating liver disease in HIV/HCV coinfected persons. (HEPATOLOGY 2005;41:123-131.)

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“…Treatment of both HIV and HCV is more complex in co-infected patients because of liver toxicity and drug interactions. [Bonacini and Puoti, 2000;Khalili and Behm, 2002;Mohsen et al, 2002;Thomas, 2002;Gonzalez and Talal, 2003;Sterling et al, 2003;Sulkowski and Thomas, 2003;Rockstroh and Spengler, 2004;Winnock et al, 2004].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C virus seropositivity in a South African Cohort of HIV co‐infected, ARV naïve patients is associated with renal insufficiency and increased mortality

Parboosing

Paruk

Lalloo

2008

Journal of Medical Virology

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HIV is known to affect the epidemiology, transmission, pathogenesis and natural history of HCV infection whilst studies on the effects of HCV on HIV have shown conflicting results and are confounded by the influence of intravenous drug use and antiretroviral therapy. This study was conducted in KwaZulu-Natal Province in South Africa where HIV is predominantly a sexually transmitted infection. Intravenous drug use is rare in this region and the study population was naïve to antiretroviral therapy. For this study, specimens from selected sentinel sites submitted to a central laboratory for routine HIV testing were screened for anti-HCV IgG antibodies. HIV positive HCV-positive patients were compared to HIV-positive HCV-negative patients in a subgroup of patients within this cohort in order to determine if HCV sero-prevalence was associated with clinical outcomes in a linked anonymous retrospective chart survey. The prevalence of HCV was 6.4% and that of HIV, 40.2% (n = 1,937). There was a significantly higher prevalence of HCV among HIV infected patients as compared to HIV negative patients (13.4% vs. 1.73% respectively) (n = 1,937, P < 0.001). HCV-HIV co-infected patients had significantly increased mortality (8.3 vs. 21%) (n = 162, P < 0.02). A significant association was found between HCV serostatus and abnormal urea levels (15.4 vs. 7.3 mmol/L, n = 134, P < 0.001) and creatinine levels (252.2 vs. 144.4 micromol/L, n = 134, P < 0.01). This study has found that hepatitis C co-infection is more common in HIV positive individuals and is associated with an increased mortality and renal morbidity.

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The Clinical Spectrum of Hepatitis C Virus in HIV Coinfection

Cited by 51 publications

References 59 publications

Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection

Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection

The effect of antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection

Hepatitis C virus seropositivity in a South African Cohort of HIV co‐infected, ARV naïve patients is associated with renal insufficiency and increased mortality

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