Extensive liver fibrosis in HIV-Hepatitis C co-infected patients compared to HCV mono-infected patients

HIV, Age, and the Severity of Hepatitis C Virus–Related Liver Disease: A Cohort Study.

Kirk GD, Mehta SH, Astemborski J, Galai N, Washington J, Higgins Y, Balagopal A, Thomas DL. Ann Intern Med. 2013;158(9):658-666

Background: Persons with HIV infection have been reported to develop age-related diseases at younger ages than those without HIV. Whether this finding is related to HIV infection or failure to control for other risk factors is unknown.

Objective: To investigate whether persons with HIV infection develop hepatitis C virus (HCV)–related liver disease at younger ages than similar persons without HIV.

Design: Comparison of the severity of liver fibrosis by age among persons who have HCV with and without HIV followed concurrently in the same protocol.

Setting: Observational cohort from Baltimore, Maryland, participating in the ALIVE (AIDS Linked to the IntraVenous Experience) study.

Participants: 1176 current and former injection drug users with antibodies to HCV.

Measurements: Liver fibrosis assessed semiannually from 2006 to 2011 by elastography (FibroScan, Echosens, Paris, France) and using previously validated thresholds for clinically significant fibrosis and cirrhosis; concurrent assessment of medical history, alcohol and illicit drug use, HCV RNA levels, hepatitis B virus surface antigen level, body mass index, and (for those with HIV) CD4+ lymphocyte count and HIV RNA levels.

Results: Among 1176 participants with antibodies to HCV, the median age was 49 years and 34% were coinfected with HIV and HCV. Participants contributed 5634 valid liver fibrosis measurements. The prevalence of clinically significant fibrosis without cirrhosis (12.9% vs. 9.5%) and of cirrhosis (19.5% vs. 11.0%) was greater in persons coinfected with HIV and HCV than in those with only HCV (P < 0.001). Increasing age and HIV infection were independently associated with liver fibrosis, as were daily alcohol use, chronic hepatitis B virus infection, body mass index greater than 25 kg/m2, and greater plasma HCV RNA levels. When these factors were kept constant, persons with HIV had liver fibrosis measurements equal to those of persons without HIV, who were, on average, 9.2 years older.

Limitation: The process of liver fibrosis began before the study in most persons.

Conclusion: In this cohort, persons who have HCV with HIV have liver fibrosis stages similar to those without HIV who are nearly a decade older.

Abstract access [1] 

Editor’s notes: Patients with HIV/HCV co-infection have markedly increased rates of liver disease, liver failure and death compared to patients with HCV mono-infection. Due to the shared routes of infection, HIV-infection is highly prevalent in individuals with HCV infection, and the co-infection rate of 34% seen in this study is typical of the reported US figures. Although ART has led to some improvement in outcomes, morbidity and mortality are still excessive in HIV/HCV co-infected patients. This is in part due to difficulties in initiating, adhering to, and managing the side effects of treatment, and also reflects increased exposures to other risk factors such as excessive alcohol use. This cohort study confirms the previously described findings of increased rates of liver fibrosis, with or without cirrhosis, in HIV/HCV co-infected patients compared to HCV mono-infected patients. This association remained highly significant even after careful adjustment for age and other factors associated with disease severity such as alcohol use, chronic hepatitis B infection, body-mass index and hepatitis C viral load. Within the subgroup of HIV/HCV co-infected individuals, the presence of clinically significant fibrosis was associated with lower CD4 cell counts and higher HIV viral loads, but interestingly not ART. These findings emphasize the importance of defining effective new treatment regimens for HCV in HIV co-infected individuals.

Comorbidity [4], People living with HIV [5]
Northern America [6]
United States of America [7]
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