Progression of Chronic Hepatitis C to Liver Fibrosis and Cirrhosis in Patients Coinfected with Hepatitis C Virus and Human Immunodeficiency Virus

Abstract

To evaluate the factors associated with the evolution of chronic hepatitis C in human immunodeficiency virus (HIV)-infected patients, a cross-sectional analysis of 41 HIV-infected patients with chronic hepatitis C (known as "HIV-HCV [hepatitis C virus]-coinfected patients") and a control group of patients with chronic hepatitis C who did not have HIV infection (known as "non-HIV-infected patients") was performed. The association of histological variables with demographic parameters, HCV load and genotype, HIV load, CD4(+) T cell count, and response to highly active antiretroviral therapy (HAART) was evaluated. HIV-HCV-coinfected patients showed a significantly higher HCV load, more-advanced fibrosis, and a higher liver fibrosis progression rate (FPR) than did non-HIV-infected patients. A high HCV load and a low CD4(+) T cell count were associated with a higher FPR. The immune response induced by HAART did not influence this progression. In conclusion, HIV-HCV-infected patients, mainly such patients with a high HCV load and an immunodepressed state, have a higher FPR. An independent effect of the immune response to HAART was not evident.

Clinical laboratory assessment of hepatitis C and HIV coinfected patients according to the antiretroviral therapy received

“…Finally, our findings regarding low-grade fibrosis seen in most patients from both groups, may be correlated with the lower mean age of the patients, since the investigators who are currently studying coinfection consider that an increase in progression of liver disease caused by HCV infection occurs as of the age of 50 5,13,23 and that the lower fibrosis grades found in younger population are due to the shorter period of time elapsed since the beginning of the infection 11,14,22 . Unfortunately, based on the data currently available in our clinic, it was not possible to clearly determine how HAART therapy could influence the progression of the liver disease in the population studied.…”

“…Populations of HIV/HCV coinfection studies are predominantly young; the populations involved in studies conducted in Spain, France and Italy were 40 years old or below 4,6,13 . The population included in this study was in average 41 years old.…”

HIV coinfection shortens the survival of patients with hepatitis C virus‐related decompensated cirrhosis†

“…The progression of liver fibrosis is faster in coinfected patients than in HCV-monoinfected individuals. [1][2][3] Moreover, HIV infection accelerates the emergence of decompensated HCV-related cirrhosis. 4,5 Likewise, mortality due to liver disease is increased in patients with chronic hepatitis C and HIV coinfection.…”

HIV Co-Infections with Hepatitis B and C

“…Patients with hepatitis C and underlying HIV progress faster to cirrhosis than patients with hepatitis C alone [64,65]. Risk factors associated with higher rates of advanced fibrosis include alcohol use, age and low CD4 T-cell counts <200 cells/µl [64,66].…”