Transient elastography discloses identical distribution of liver fibrosis in chronic hepatitis C between HIV-negative and HIV-positive patients on HAART

Abstract

ObjectiveProgressive immunodeficiency associated with HIV-infection leads to a progressive course of liver disease in HIV/HCV-co-infected patients. Highly active antiretroviral therapy (HAART) efficiently restores and preserves immune functions and has recently been demonstrated to also result in reduced liver-related mortality in HIV/HCV-co-infected patients.MethodsTo analyse differences in current liver fibrosis as a possible effect of HAART on fibrosis progression we assessed hepatic fibrosis by transient elastography in a cross-sectional comparison between HCV-mono-infected and HIV/HCV-co-infected patients presenting at our outpatient department in 2007.ResultsOverall, we did not find any difference in the distribution of liver stiffness between mono- (n = 84) and double-infected (n = 57) patients (14.4 kPa (10.8 - 18.2) versus 12.4 kPa (9.1 - 16.1), mean (95%-CI)). However, in the 8 HIV+ patients with CD4 counts < 200/μl liver stiffness was markedly greater (18.4 kPa (0.8 - 36.0)) than in HIV+ patients with preserved immunity (11.5 kPa (8.4 - 15.0)).ConclusionsThese findings are in line with other data that show an improved prognosis of chronic hepatitis C in HIV+ patients under effective HAART, and may be a hint that fibrosis progression in well-treated HIV+ patients will no longer be different from that in HCV-mono-infected patients.

Sustained Long-Term Antiviral Maintenance Therapy in HCV/HIV-Coinfected Patients (SLAM-C)

“…However, Brau et al has reported slower fibrosis progression in coinfected patients with HAART-associated HIV suppression 21. This is further supported by a recent paper which used transient elastography to suggest that fibrosis rates in HCV/HIV coinfected subjects was now similar that seen in HCV monoinfection 22. Finally, we suspect that there has been a significant evolution in antiretroviral therapy which is reflected in decreased rates of drug-associated hepatoxicity.…”

Influence of antiretroviral therapy on liver disease

“…Moreover, a cross-sectional comparison between coinfected patients on ART and HCV-monoinfected patients observed no difference in the distribution of liver stiffness [46].…”

Prevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth

“…There is evidence to suggest that HIV interacts directly with multiple liver cell types[8–17]. Furthermore, some studies in adults have shown an association between control of HIV replication and favorable effect on liver fibrosis either by histopathology[18], or by novel approaches such as transient elastography[19], leading to speculation that these findings may be partly explained by interactions between hepatic stellate cells and HIV glycoproteins resulting in stimulation of collagen production[20]. …”