Slower fibrosis progression in HIV/HCV-coinfected patients with successful HIV suppression using antiretroviral therapy

被引:276
作者
Bräu, N
Salvatore, M
Ríos-Bedoya, CF
Fernández-Carbia, A
Paronetto, F
Rodríguez-Orengo, JF
Rodríguez-Torres, M
机构
[1] Vet Adm Med Ctr, Infect Dis Sect 111F, Bronx, NY 10468 USA
[2] CUNY Mt Sinai Sch Med, New York, NY 10029 USA
[3] Ponce Sch Med, Ponce, PR USA
[4] Univ Pathologists, San Juan, PR USA
[5] Univ Puerto Rico, Sch Med, San Juan, PR 00936 USA
[6] Fdn Invest Diego, San Juan, PR USA
关键词
hepatitis C; HIV; viral load; fibrosis progression; highly-active antiretroviral therapy;
D O I
10.1016/j.jhep.2005.07.006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/Aims: HIV/HCV-coinfected patients reportedly have a faster fibrosis progression rate (FPR) than HCV-monoinfected patients. This study examined whether HIV suppression through highly active antiretroviral therapy (HAART) attenuates this accelerated fibrosis progression. Methods: In two hepatitis C centers, a retrospective analysis identified 656 consecutive treatment-naive HCV-infected patients who had undergone a liver biopsy, had a presumed date of HCV infection, and had been tested for HIV, 274 of them HIV-positive (95.2% on HAART) and 382 HIV-negative. The primary outcome measure was the FPR, defined as Ishak fibrosis score [0-6] over estimated duration of HCV infection. Results: Among HIV/HCV-coinfected patients, 51.2% had undetectable HIV RNA (< 400 copies/mL). There was no difference in FPR between HIV/HCV-coinfected and HCV-monoinfected patients (0.136 vs. 0.128 Ishak fibrosis units/year, P = 0.29). However, HIV/HCV-coinfected patients with any detectable HIV viral load > 400 copies/mL had a faster FPR (0.151) than HCV-monoinfected patients (0.128, P=0.015) and than HIV/HCV-coinfected patients with undetectable plasma HIV RNA (0.122, P = 0.013) who in turn had the same FPR as HCV-monoinfected subjects (0.128, P=0.52). An accelerated FPR in HIV viremic patients was seen with CD4+ cells < 500/mm(3) (0.162 vs. 0.123, undetectable HIV RNA, P = 0.005) but not with CD4+ cells > 500/mm(3) (0.118 vs. 0.121, P=0.89). In multivariable linear regression analysis of HIV/HCV-coinfected patients, log(10) HIV RNA level, necroinflammation, and age at HCV infection were independently correlated to FPR, but not alcohol use or CD4+ cell count (r(2) = 0.45 for model). Conclusions: HIV/HCV-coinfected patients with undetectable HIV RNA through HAART have a slower FPR than those with any HIV RNA level and an FPR similar to HCV-monoinfected individuals. (c) 2005 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:47 / 55
页数:9
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