Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus

• Published in: Hepatology (Baltimore, Md.) Vol. 50; no. 4; pp. 1056 - 1063
• Main Authors: Macías, Juan, Berenguer, Juan, Japón, Miguel A., Girón, José A., Rivero, Antonio, López‐Cortés, Luis F., Moreno, Ana, González‐Serrano, Mercedes, Iribarren, José A., Ortega, Enrique, Miralles, Pilar, Mira, José A., Pineda, Juan A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2009; Wiley
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Antiviral Agents - therapeutic use; Biological and medical sciences; Biopsy; Cohort Studies; Digestive system; Disease Progression; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepacivirus - pathogenicity; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C - pathology; HIV - pathogenicity; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - pathology; Humans; Interferon-alpha - therapeutic use; Investigative techniques, diagnostic techniques (general aspects); Liver - pathology; Liver - virology; Liver Cirrhosis - epidemiology; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Multivariate Analysis; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Polyethylene Glycols - therapeutic use; Prospective Studies; Recombinant Proteins; Retrospective Studies; Ribavirin - therapeutic use; Risk Factors; Human; Liver biopsy; Mixed infection; Prognosis; Retroviridae; Lentivirus; Virus; Fibrosis; Gastroenterology; Evolution; Human immunodeficiency virus; Flaviviridae; Hepatitis C virus; Hepacivirus
• ISSN: 0270-9139; 1527-3350; 1527-3350
• DOI: 10.1002/hep.23136

A few studies have assessed the observed fibrosis progression between serial liver biopsies (LB) in human immunodeficiency virus (HIV) / hepatitis C virus (HCV)‐coinfected patients. Approximately half of the patients progressed at least one fibrosis stage over a short period of time. The risk factors for this fast progression need clarification. Because of this, we evaluated the observed fibrosis progression rates of HIV/HCV‐coinfected patients and the risk factors for accelerated progression. Overall, 135 HIV‐infected patients with positive serum HCV RNA, without other possible causes of liver disease, who underwent two LB, separated at least by 1 year, were included in this retrospective cohort study. The median (Q1‐Q3) time between both LBs was 3.3 (2.0‐5.2) years. Patients showed the following changes in fibrosis stage: regression ≥1 stage: 23 (17%), no change: 52 (39%), progression 1 stage: 38 (28%), and progression ≥2 stages: 22 (16%). Seventeen (13%) patients had cirrhosis in the second biopsy. Factors independently associated with progression ≥1 stage were undetectable plasma HIV RNA during the follow‐up (relative risk [RR] [95% confidence interval, 95% CI] 0.61 [0.39‐0.93], P = 0.03), moderate‐to‐severe lobular necroinflammation (1.77 [1.16‐2.7], P = 0.009), time between biopsies (1.11 [1.08‐1.2], P = 0.01), and end of treatment response to anti‐HCV therapy (0.41 [0.19‐0.88], P = 0.02). Conclusion: Fibrosis progresses with high frequency in HIV/HCV‐coinfected patients over a period of time of 3 years. Absent‐to‐mild lobular necroinflammation at baseline, achievement of response with anti‐HCV treatment, and effective antiretroviral therapy are associated with slower fibrosis progression. (HEPATOLOGY 2009.)