Journal Article

Do Type and Duration of Antiretroviral Therapy Attenuate Liver Fibrosis in HIV—Hepatitis C Virus—Coinfected Patients?

Sumita Verma, Chun-Hsiang Wang, Sugantha Govindarajan, Gary Kanel, Kathleen Squires and Maurizio Bonacini

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 2, pages 262-270
Published in print January 2006 | ISSN: 1058-4838
Published online January 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/499055
Do Type and Duration of Antiretroviral Therapy Attenuate Liver Fibrosis in HIV—Hepatitis C Virus—Coinfected Patients?

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Background. This study aimed to determine whether type and duration of therapy for human immunodeficiency virus (HIV) infection attenuates liver fibrosis in patients with HIV and hepatitis C virus (HCV) coinfection.

Methods. Patients with HCV monoinfection (group 1) and HIV-HCV coinfection were retrospectively selected; the latter patients were classified into the following 3 groups: group 2, patients who received no therapy or only nucleoside reverse-transcriptase inhibitors (NRTIs); group 3, those who received highly active antiretroviral therapy (HAART); and group 4, those who initially received NRTIs followed by HAART. Fibrosis stage (scale, 0–6) and necroinflammatory score (scale, 0–18) were assessed according to the Ishak system. Data are presented as mean ± standard deviation.

Results. Three hundred eighty-one patients (296 HCV-monoinfected patients and 85 HIV-HCV—coinfected patients) were recruited. The durations of HIV therapy before liver biopsy was performed for groups 2, 3, and 4 were 3.8 ± 2.8, 3.3 ± 1.8, and 6.6 ± 2.2 years. The time from HIV diagnosis to HAART initiation was shorter for group 3 than for group 4 (9.1 ± 7.3 vs. 34.1 ± 13.1 months; P < .0001). Groups 1 and 3 had similar fibrosis stages (3.1 ± 2 vs. 3.4 ± 2.4), rates of fibrosis progression (0.13 ± 0.09 vs. 0.16 ± 0.11 per year), and necroinflammatory scores (6.1 ± 1.8 vs. 6.1 ± 2.0). Groups 2 and 4 had significantly more-advanced liver disease, as determined by fibrosis stage (4.6 ± 1.8 vs. 4.3 ± 2.0; P < .0009), rate of fibrosis progression (0.24 ± 0.11 vs. 0.20 ± 0.10 per year; P < .0001), and prevalence of cirrhosis (68% vs. 55%; P < .006), compared with group 1.

Conclusions. HIC-HCV—coinfected subjects who receive HAART as their sole form of therapy have liver histology findings comparable to those for HCV-monoinfected patients. A similar degree of benefit is not observed for HIV-HCV—coinfected patients who receive no therapy, NRTIs, or HAART after NRTIs, despite having a longer duration of therapy.

Journal Article.  4555 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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