Causative factors of liver fibrosis in HIV-infected patients. A single center study

Abstract

Background Liver disease is a leading cause of morbidity and mortality among Human Immunodeficiency virus (HIV) infected patients; however no consensus exists on HIV-related risk factors for it. The aim of this study was to identify risk factors for liver fibrosis/cirrhosis in a cohort of Greek HIV-infected patients. Methods Patients attending the HIV outpatient clinic of Pathophysiology Department at «Laiko» General Hospital in Athens, Greece, between December 2014 and December 2017 were eligible for inclusion. Inclusion criteria were confirmed HIV infection and age > 18 years. Exclusion criteria were Body-Mass index (BMI) > 40, liver metastases of malignant diseases and concurrent or previous chemotherapy. Liver stiffness (LS) was measured using Vibration Controlled Transient Elastography (TE) and laboratory tests were acquired in all patients. Patients were classified in 2 groups: those with mild or no fibrosis (equivalent to Metavir score F0-F2) and those with significant fibrosis (equivalent to Metavir score F3-F4). Results A total of 187 consecutive patients were included in this study. Median TE value was 5.1 kilopascals (KPa) (range 2.8–26.3), with 92.5% (173/187) of the patients having no/mild fibrosis and 7.4% (14/187) significant fibrosis. On multivariate logistic regression analysis older patient’s age, abnormal serum aspartate aminotransferase (AST) value, Hepatitis C virus (HCV) infection, alcohol abuse, CD4/CD8 ratio and an increased number of liver related events (LREs) were significantly correlated with liver fibrosis/cirrhosis. Conclusions In our cohort of HIV-infected individuals HCV/HIV co-infection, older age, alcohol abuse and CD4/CD8 ratio seem to correlate with fibrogenesis in the liver.

Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection

“…Several studies have confirmed the possible causes contributing to the progression of liver fibrosis in PLWH, in particular, age, coinfections with viral hepatitis and alcohol abuse [ 19 , 20 , 21 , 22 , 23 , 24 ]. On the other hand, the potential effect of body mass index and the presence of hypertriglyceridemia or diabetes mellitus are debated and inconclusive [ 22 , 25 ].…”

Association of Hepatitis B Core-Related Antigen and Antihepatitis B Core Antibody With Liver Fibrosis Evolution in Human Immunodeficiency Virus-Hepatitis B Virus Coinfected Patients During Treatment With Tenofovir

“…Human immunodeficiency virus-induced immunosuppression has been shown to affect levels of qAnti-HBc, but not particularly qHBcrAg [ 32 ], and longer periods of HIV infection have been associated with higher degrees of biopsy-assessed liver fibrosis [ 33 ], both of which could have affected the association between these markers and fibrosis. Human immunodeficiency virus virological and immunological variables did not borne out as determinants for transitions between liver fibrosis states, with the exception of CD4 + /CD8 + ratio during follow-up and liver fibrosis regression (HR = 2.90; 95% CI, 1.41–5.97), which has been associated with liver fibrosis levels in HIV infection [ 25 , 26 ] and was adjusted for in our model. Other confounding variables include ART-related hepatotoxicity and metabolic hepatic manifestations.…”

“…The hazard ratios (HRs) comparing TI per unit increase in marker levels at baseline, during follow-up and change between visits, were estimated with proportional hazards of the TI. Multivariable adjustment was made using predefined covariates from a previous study in TDF-treated coinfected patients: age, gender, duration of ART, and protease inhibitor (PI)-containing ART [ 7 ], as well as CD4 + /CD8 + ratio during follow-up [ 25 , 26 ]. Model fit was assessed by plotting the observed and expected prevalence of belonging to a given fibrosis group [ 27 ].…”

Liver Fibrosis during Antiretroviral Treatment in HIV-Infected Individuals. Truth or Tale?

“…Apart from those already mentioned, other factors associated with significant LF appear to be chronically elevated serum alanine aminotransferase (ALT) and gamma glutamyl-aminotransferase (γGT) levels, while findings concerning body-mass index and the presence of hypertriglyceridemia or diabetes mellitus (common predisposing factors for NAFLD) are inconsistent [ 26 , 28 , 30 , 32 , 33 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…Several studies have explored the possible causes of liver fibrosis in HIV-infected patients, with most of them pointing out viral hepatitis co-infections, age, and alcohol abuse as the major risk factors [ 16 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. On the other hand, the long-term hepatotoxicity of ART has been debated, with various studies remaining inconclusive.…”