icon-folder.gif   Conference Reports for NATAP  
  American Association for the Study of Liver Diseases 2003 Conference
Boston, MA
Oct 24-28, 2003
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  Reported by Jules Levin
Luz Martin-Carbonero and European researchers reported at AALSD that HCV/HIV co-infected patients show advanced liver fibrosis.
Chronic hepatitis C is becoming one of the leading causes of morbidity and mortality among HIV+ persons infected parenterally. Liver fibrosis progress faster in the setting of HIV infection. Factors involved in fibrosis progression in the HAART era are not well defined.
As part of an European, multicenter, retrospective survey, all participants were invited to fill a case report form with the main demographics, clinical, laboratory, and histological findings from HIV/HCV-coinfected patients with elevated ALT levels. Univariate and multivariate multinomial logistic regression analysis was performed to calculate odds ratio (OR) and 95% confidence intervals (95%CIs) for having moderate (F2) or severe fibrosis (F3-F4) with respect to lack or mild fibrosis (F0-F1).
914 patients were included. 75% were male, 83% IDUs and 25% admitted former or current alcohol intake >80 g/d. Median age and HCV estimated duration of infection were 37 and 16 years, respectively. Median CD4 count was 480 cells/ul. 70% were on antiretroviral treatment. HCV genotype distribution was 1 (56%), 2 (2%), 3 (32%) and 4 (9%). Liver fibrosis stage was F0 (10%), F1 (33%), F2 (22%), F3 (22%) and F4 (13%). It was 8%, 28%, 20%, 25% and 18% for patients elder than 35 years. In the multivariate analysis, older age and higher alcohol intake were the only factors related to higher fibrosis grades. Gender, age at infection, HCV genotype, HCV load, CD4 counts or antiretroviral treatment were nor related with fibrosis.
Up to 1/3 of HIV/HCV-coinfected patients shows advanced liver fibrosis. As this rate increase with age, more complications due to end-stage liver disease should be expected. Given that fibrosis progresses with age and treatment response decreases in cirrhotics, HCV therapy should not be delayed in most HIV/HCV-coinfected patients.