Prevalence and factors associated with significant liver fibrosis assessed by transient elastometry in HIV/hepatitis C virus-coinfected patients

Abstract

Transient elastometry (TE) could provide a more accurate evaluation of the frequency and risk factors of liver fibrosis in hepatitis C virus (HCV) infection than that based on biopsy. The aim of this study was to assess the prevalence of and factors associated with significant liver fibrosis in a large population of HIV/HCV-coinfected patients. HIV/HCV-coinfected patients, who had participated in a cross-sectional, multicenter, retrospective study of liver fibrosis using noninvasive markers and in whom a determination of liver stiffness (LS) by TE was available, were included in this analysis. Factors potentially associated with significant fibrosis (LS ≥ 9 kPa) were analyzed. One thousand three hundred and ten patients fulfilled the inclusion criteria, 526 (40%) of them showed LS ≥ 9 kPa and 316 (24%) cirrhosis (LS ≥ 14 kPa). The factors independently associated with significant fibrosis [adjusted odds ratio (95% confidence interval, P value) were the following: older age [1.04 (1.01-1.07), 0.002], daily alcohol intake > 50 g/day [1.58 (1.10-2.27), 0.013] and the length of HCV infection [1.03 (1.00-1.06), 0.023]]. A CD4 cell count lower than < 200 per mm(3) [1.67 (0.99-2.81), 0.053] and HCV genotype 4 [0.66 (0.42-1.02), 0.066] were marginally associated with LS ≥ 9 kPa. In conclusion, the prevalence of cirrhosis in HIV/HCV-coinfected patients seems to be higher than previously reported in studies based on liver biopsy. Older age, alcohol consumption and lower CD4 cell counts are related with significant fibrosis. The latter association supports an earlier starting of antiretroviral therapy in this setting.

Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis

“…27,28 However, an association between lower CD4 count and liver fibrosis has been noted primarily in HIV-HCV coinfected cohorts 6,29–35 and has not been examined as extensively across all CD4 levels over time, in conjunction with HIV VL or in HIV monoinfected patients.…”

Risk factors for liver fibrosis among human immunodeficiency virus monoinfected patients using the FIB4 index in Morocco

“…Also, age ≥ 40 was a high factor for liver fibrosis progression in HIV [30] . In HIV-HVC co-infected patients, older age was found to be an independent factor for advanced liver fibrosis measured by elastometry [31] . Another interesting result of our study is that ART use and its duration were not independently associated with liver fibrosis.…”

Insulin resistance is associated with a higher risk of hepatocellular carcinoma in cirrhotic HIV/HCV-co-infected patients: Results from ANRS CO13 HEPAVIH

“…In HIV-infected patients, antiretroviral therapy increases the risk of overt diabetes, especially in case of body fat abnormalities and exposure to certain protease inhibitors or to the D-thymidine nucleoside analogues stavudine and zidovudine [18,19]. IR, independently of visceral obesity, liver steatosis and type 2 diabetes, has been linked to advanced liver fibrosis in several studies of HCV-mono-infected and HIV/HCV-co-infected patients [17,20,21]. The biological mechanisms underlying the association between fibrosis and IR are not fully understood but appear to involve the ability of insulin to stimulate hepatic stellate cells, leading to increased production of connective-tissue growth factor and to extracellular matrix accumulation [17,[20][21][22].…”