The natural history of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected patients has never been studied according to the concept of liver fibrosis progression. The aim of this work was to assess the fibrosis progression rate in HIV-HCV coinfected patients and in patients infected by HCV only. A cohort of 122 HIV-HCV coinfected patients was compared with a control group of 122 HIV-negative HCV-infected patients. Groups were matched according to age, sex, daily alcohol consumption, age at HCV infection, and duration and route of HCV infection. The fibrosis progression rate was defined as the ratio between fibrosis stage (METAVIR scoring system) and the HCV duration. The prevalence of extensive liver fibrosis (METAVIR fibrosis scores 2, 3, and 4) and moderate or severe activity were higher in HIV-infected patients (60% and 54%, respectively) than in control patients (47% and 30%, respectively; P F .05 and P F .001, respectively). The median fibrosis progression rate in coinfected patients and in control patients was 0.153 (95% confidence interval [CI], 0.117-0.181) and 0.106 (95% CI, 0.084-0.125) fibrosis units per year, respectively (P F .0001). HIV seropositivity (P F .0001), alcohol consumption (G50 g/d, P ؍ .0002), age at HCV infection (F25 years old, P F .0001), and severe immunosuppression (CD4 count I200 cells/L, P F .0001) were associated with an increase in the fibrosis progression rate. In coinfected patients, alcohol consumption (G50 g/d), CD4 count (I200 cells/L), and age at HCV infection (F25 years old) (P F .0001, respectively) were associated with a higher fibrosis progression rate. HIV seropositivity accelerates HCV-related liver fibrosis progression. In coinfected patients, a low CD4 count, alcohol consumption rate, and age at HCV infection are associated with a higher liver fibrosis progression rate. (HEPATOLOGY 1999;30:1054-1058.)
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share the same parenteral routes of transmission. The prevalence of HCV antibodies in HIV-infected patients ranges from 8% in homosexual men, 1 to 60% in hemophiliacs, 2 or 80% in intravenous (IV) drug users. An increase in survival of HIV-infected persons related to active antiretroviral therapies 4,5 highlights the problem of chronic hepatitis C in HIV-coinfected patients. HCV-related liver disease may be more severe in HIV-infected people than in non-HIV-infected individuals. The prevalence of cirrhosis may be 3-fold higher in HIV-HCV coinfected patients than in HIV-negative HCV-infected patients, 9,10 and one third of coinfected patients is at risk of dying of liver disease. 11 These results were obtained by comparing HIV-positive patients with HIV-negative patients matched only with respect to the route of infection, sex, or age. No attention was given to alcohol consumption, duration of HCV infection, or age at HCV infection. However, in HIV-negative HCV-infected individuals, age at infection, alcohol consumption, and sex are independent factors influencing the rate of HCV-related liver fibrosis progression. 12 Thus, a greater severity of HCV infection, especially related to HIV coinfection, remains to be shown by using a multivariate analysis considering these factors. Moreover, the concept of liver fibrosis progression, as previously defined, 12 may be a reliable tool to perform such an analysis. Thus, the aims of this study were (1) to determine the fibrosis progression rate in HIV-HCV coinfected patients compared with HIV-negative HCV-infected patients, (2) to investigate the role of HIV coinfection on the fibrosis progression rate, and (3) to identify factors independently correlated with the fibrosis progression rate in HIVinfected patients, with specific attention to the immune status and factors affecting the liver fibrosis progression previously identified in patients infected only with HCV.
PATIENTS AND METHODS
Patients
Patients included in the study belonged to a single center cohort (DOSVIRC). This cohort includes all the patients with hepatitis C (defined as a positive serology result by at least a second generation enzyme-linked immunosorbent assay [ELISA] test) followed-up in Abbreviations: HIV, human immunodeficiency virus; HCV, hepatitis C virus; IV, intravenous; ELISA, enzyme-linked immunosorbent assay; METAVIR, xxx; HAART, highly active antiretroviral therapy; NRTI, nucleoside analogue reverse transcriptase inhibitors; CI, confidence interval.
From the 1 Service d'He ´pato-Gastroente ´rologie, Groupe Hospitalier Pitie ´Salpe ˆtrie `re and UPRES-A 8067