Liver Fibrosis Progression in Human Immunodeficiency Virus and Hepatitis C Virus Coinfected Patients

Hepatology, October 1999, p. 1054-1058, Vol. 30, No. 4

Yves Benhamou1, Marie Bochet2, Vincent Di Martino1, Frederic Charlotte3, Felipe Azria1, Anne Coutellier4, Michel Vidaud1, Fran┴ois Bricaire2, Pierre Opolon1, Christine Katlama2, and Thierry Poynard1 for the for the MULTIVIRC Group

From the 1Service d'H╚pato-Gastroent╚rologie, Groupe Hospitalier Piti╚  Salp═tri╦re and UPRES-A 8067, Paris, France; 2Service de Maladies  Infectieuses, Groupe Hospitalier Piti╚-Salp═tri╦re, Paris, France; 3 Service d'Anatomie Pathologique, Groupe Hospitalier Piti╚-Salp═tri╦re,  Paris, France; and 4Service de M╚decine Interne, Groupe Hospitalier  Piti╚-Salp═tri╦re, Paris, France.

The natural history of hepatitis C virus (HCV) infection in human

immunodeficiency virus (HIV)-infected patients has never been studied  according to the concept of liver fibrosis progression. The aim of this  work was to assess the fibrosis progression rate in HIV-HCV coinfected patients and in patients infected by HCV only. A cohort of 122 HIV-HCV coinfected patients was compared with a control group of 122 HIV-negative HCV-infected patients. Groups were matched according to age, sex, daily alcohol consumption, age at HCV infection, and duration and route of HCV infection. The fibrosis progression rate was defined as the ratio between fibrosis stage (METAVIR scoring system) and the HCV duration. The prevalence of extensive liver fibrosis (METAVIR fibrosis scores 2, 3, and 4) and moderate or severe activity were higher in HIV-infected patients (60% and 54%, respectively) than in control patients (47% and 30%, respectively; P < .05 and P < .001, respectively). The median fibrosis progression rate in coinfected patients and in control patients was 0.153 (95% confidence interval [CI], 0.117-0.181) and 0.106 (95% CI, 0.084-0.125) fibrosis units per year, respectively (P < .0001). HIV seropositivity (P < .0001), alcohol consumption (>50 g/d, P = .0002), age at HCV infection (<25 years old, P < .0001), and severe immunosuppression (CD4 count 200 cells/ÁL, P < .0001) were associated with an increase in the fibrosis progression rate. In coinfected patients, alcohol consumption (>50 g/d), CD4 count (200 cells/ÁL), and age at HCV infection (<25 years old) (P < .0001, respectively) were associated with a higher fibrosis

progression rate. HIV seropositivity accelerates HCV-related liver fibrosis progression. In coinfected patients, a low CD4 count, alcohol consumption rate, and age at HCV infection are associated with a higher liver fibrosis progression rate.