Advanced liver fibrosis in HIV/HCV-coinfected patients on antiretroviral therapy

HIV infection is believed to adversely affect the progression of hepatitis C virus (HCV)-related liver disease. However, information regarding HIV and HCV coinfection in the era of highly active antiretroviral therapy (HAART) is scarce. A cross-sectional study in 75 HCV/HIV-coinfected patients (most of them on HAART) and 75 HCV-monoinfected patients paired by age, sex, and date of liver biopsy analyzed the association of HIV infection with advanced liver fibrosis (Knodell fibrosis stages 3 + 4). The median CD4 cell count in HIV-coinfected patients was 546 cells/mul; 78.7% had an HIV-1 viral load < 1000 copies/ml and 88% were on antiretroviral therapy. The percentage of patients harboring genotype 4 and with a higher HCV viral load was greater in the HIV-coinfected group. HCV/HIV-coinfected patients had more advanced liver fibrosis ( Knodell fibrosis stages 3 + 4) than HCV-monoinfected patients (46.7% vs. 12%, p < 0.0001). In the univariate analysis, the factors associated with advanced liver disease were male sex ( OR: 2.7, 95% CI: 1.05 - 7.1), history of injecting drug use ( OR: 4.6, 95% CI: 2.0 - 10.2), HIV infection ( OR: 6.4, 95% CI: 2.7 - 14.7), and previous exposure to therapy with protease inhibitors ( OR: 3.0, 95% CI: 1.4 - 6.3). In the multivariate analysis; only male sex ( OR: 3.17, 95% CI: 1.152 - 8.773) and HIV infection ( OR: 6.85, 95% CI: 2.93 - 16.005) were associated with advanced liver fibrosis. HIV infection is associated with advanced liver fibrosis. HIV/HCV-coinfected individuals on HAART are at risk of developing end-stage liver disease despite virological success and immunological reconstitution.