The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: A long-term retrospective cohort study

Abstract

In this study we analyzed the influence of human immunodeficiency virus (HIV) infection on the course of chronic hepatitis C through multivariate analysis including age, alcohol consumption, immune status, and hepatitis C virus (HCV)-related virologic factors. Eighty HIV-positive and 80 HIV-negative injection drug users included between 1980 and 1995 were matched according to age, gender, and duration of HCV infection and followed-up during 52 months. The progression to cirrhosis was the primary outcome measure. The impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy, and liver-related death was also considered. In HIV-positive patients, chronic hepatitis C was characterized by higher serum HCV-RNA levels (P ‫؍‬ .012), higher total Knodell score (P ‫؍‬ .011), and poorer sustained response to interferon therapy (P ‫؍‬ .009). High serum HCV-RNA level was associated with low CD4-lymphocyte count (P ‫؍‬ .001). Necroinflamatory score was higher in HIV-positive patients (P ‫؍‬ .023) independently of the CD4-lymphocyte count, whereas increased fibrosis was related to decreased CD4-lymphocyte count (P ‫؍‬ .011). The progression to cirrhosis was accelerated in HIV-positive patients with low CD4 cell count (RR ‫؍‬ 4.06, P ‫؍‬ .024) and in interferon-untreated patients (RR ‫؍‬ 4.76, P ‫؍‬ .001), independently of age at HCV infection (P ‫؍‬ .001). Cirrhosis caused death in 5 HIV-positive patients. The risk of death related to cirrhosis was increased in heavy drinkers (RR ‫؍‬ 10.8, P ‫؍‬ .001) and in HIV-positive patients with CD4 cell count less than 200/mm 3 (RR ‫؍‬ 11.9, P ‫؍‬ .007). In this retrospective cohort study, HIV coinfection worsened the outcome of chronic hepatitis C, increasing both serum HCV-

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

“…83,100,101 Studies have shown that chronic hepatitis C patients with HIV infection have a worse prognosis as compared to those without HIV. [102][103][104][105][106][107] Coinfection with HIV and HCV is associated with a lower rate of spontaneous HCV RNA clearance. 108 There is an increased rate of fibrosis in HIV and HCV coinfected patients, with an accelerated progression of HCV-related liver disease.…”

There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV

“…Several studies conducted before the introduction of highly active antiretroviral therapy (HAART) have suggested that HIV infection changes the natural history of HCV infection, leading to more rapid progression of liver fibrosis (9,(23)(24)(25)(26)(27)(28). The progression, which typically takes 30 years or more in patients infected with HCV, could take less than half this time in co-infected patients (12).…”

Avaliação da imunidade celular nos pacientes Co-Infectados pelo vírus da hepatite C e vírus da imunodeficiência humana

“…Em outros estudos que avaliaram o tratamento de pacientes co-infectados, os valores médios foram semelhantes, variando de 478 (20) a 500 (5,7) células/mm 3 , sendo maiores que o observado na presente série. No entanto, em outros trabalhos que não incluíram apenas pacientes candidatos ao tratamento anti-VHC, a contagem média de células CD4 foi inferior à observada nesta casuística (12,31) .…”