Background
Liver disease is a major cause of mortality among HIV-infected persons. There is limited information about the extent to which HIV disease severity impacts liver disease progression.
Methods
We determined the incidence and predictors of advanced hepatic fibrosis measured by the FIB-4 index (≥3.25) in a large diverse population of HIV-infected patients without significant liver disease at baseline (FIB-4<1.45) in care between January 2000 and March 2014. We used Cox proportional hazards analysis to examine factors associated with progression to FIB-4 ≥3.25.
Results
Among 14,198 HIV-infected patients, HCV coinfection (adjusted hazard ratio [aHR] 1.9, 95% CI 1.6–2.1), HBV coinfection (aHR 1.5, 95% CI 1.2–1.8), alcohol use disorder (aHR 1.4, 95% CI 1.2–1.6) and diabetes (aHR 1.9, 95% CI 1.6–2.3) were associated with progression to advanced fibrosis in multivariable analysis. In addition, patients at each lower level of time-varying CD4 count had a significantly greater risk of progression, with a nearly 7-fold higher risk in those with CD4 <100 cells/mm3 (aHR 6.9, 95% CI 5.8–8.3) compared with CD4 ≥500 cells/mm3. An increasing gradient of risk was also observed among patients with higher time-varying HIV viral load (VL), with the greatest risk noted with VL ≥100,000 copies/ml (aHR 2.6, 95% CI 2.2–3.1) compared with VL <500 copies/ml.
Conclusion
Lower CD4 count and higher HIV VL were significantly associated with progression to advanced hepatic fibrosis in a dose-dependent manner, independent of the risk associated with traditional factors: HCV or HBV coinfection, alcohol, and diabetes. Our findings suggest that early treatment of HIV infection could mitigate liver disease.