Documented rapid course of hepatic fibrosis between two biopsies in patients coinfected by HIV and HCV despite high CD4 cell count

Abstract

In HIV/hepatitis C virus (HCV)-coinfected patients, it is recommended to repeat liver biopsy every 3 years when anti-HCV treatment is not indicated. We studied fibrosis progression in HIV/HCV-coinfected patients, who were not receiving anti-HCV treatment, on the basis of two successive liver biopsies. Thirty-two patients were retrospectively included. Twenty-six patients (79%) were on antiretroviral treatment at the first biopsy. The mean CD4 cell count was 470 +/- 283/mm(3). Three patients were staged F2 and the remainder F0/F1. The median interval between the two biopsies was 49 (24-80) months. At the second biopsy, the stage distribution was F0 0%, F1 41% (n = 13), F2 34% (n = 11), F3 19% (n = 6) and F4 6% (n = 2). The mean fibrosis progression rate (FPR) was 0.25 points/year. Nine patients (28%) were considered as rapid fibrosis progressors (progression by more than two points) and their FPR was 0.5 point/year; comparison of these subjects with the other 23 patients showed no relation between FPR and age, alcohol consumption, CD4+ cell count, HIV viral load, HCV genotype, aspartate aminotransferase or alanine aminotransferase. Analysis of the treatment received between the two liver biopsies did not find any correlation between liver FPR and a specific compound. Fifteen patients started anti-HCV therapy based on the second biopsy. Liver fibrosis in HIV/HCV-coinfected patients should be evaluated at least every 3 years, as nine of 32 (28%) of our patients progressed by at least two fibrosis points despite a high CD4+ cell count. The second biopsy showed that 15 patients (45%) qualified for anti-HCV therapy. Development of noninvasive methods of fibrosis evaluation should permit more frequent monitoring.

Fast Fibrosis Progression Between Repeated Liver Biopsies in Patients Coinfected with Human Immunodeficiency Virus/Hepatitis C Virus†

“…Anti-HCV treatment is the best-proven means of preventing chronic hepatitis C progression and complications. 5,20,21,26,27 Fast fibrosis progression in HIV/HCVcoinfected patients observed in this study and by other authors, [12][13][14] and specifically progression of patients with initial mild fibrosis, supports that pegylated interferon plus ribavirin should be indicated in this population regardless of the fibrosis stage.…”

“…9 However, paired liver biopsy studies in coinfected patients have not found any relation between HAART and fibrosis progression. [12][13][14] On the contrary, in a prospective cohort of ART-naïve patients, HAART-mediated control of HIV RNA was a protective factor for liver-related death. 5 We found that fibrosis progression between liver biopsies was independently related with HIV RNA suppression both in the global study group and in the patients without anti-HCV treatment.…”

“…[12][13][14] However, these studies are scarce and have drawbacks. Some of them are limited due to small sample size.…”

“…Some of them are limited due to small sample size. 12,13 The largest cohort study on repeated liver biopsies mostly included African-American men, 14 which may not be representative of other populations.…”

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

“…108 There is an increased rate of fibrosis in HIV and HCV coinfected patients, with an accelerated progression of HCV-related liver disease. 109 Cirrhosis develops 12-16 years earlier in patients coinfected with HIV and HCV than in those infected with HCV alone. 110 The median survival of decompensated cirrhosis in patients with HIV and HCV coinfection is only 13 months.…”