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Confounding
Finding of Lower Rates of Histologic Progression in HCV-HIV
Coinfected Patients Versus HCV Mono-infected Inmates
Reportedly, HCV-HIV co-infected patients have a faster rate
of histologic
progression than HCV infected patients. This study compares
the fibrosis indices of HCV-infected patients with HCV-HIV
co-infected patients.
A quality assurance database for the Louisiana Department of
Corrections was analyzed. Duration of infection was calculated
as the interval between onset of risk factors for HCV and
date of biopsy. Patients are biopsied if deemed potentially
eligible for therapy.
HIV co-infected patients with CD4 counts less than 300 were
not biopsied.
Fibrosis index was calculated by dividing the stage of fibrosis
by the duration of infection in years.
The HCV-HIV co-infected patients were compared to the HCV mono-infected
patients. T-test was used to establish statistical significance,
which was defined as P < 0.05. The LSU-HSC IRB approved
use of the database for this purpose. Duration of HIV infection
was not estimated.
Results
A similar analysis was done with only African American patients
in both populations. Similar results were obtained.
Table
1. Comparison of HCV Mono-infected and HCV-HIV Co-infected
Inmates
| |
Co-infected
|
HCV-infected
|
p value
|
|
N
|
39
|
442
|
|
|
Gender
|
M
|
M
|
|
|
W/B Ratio
|
5/34
|
151/291
|
|
|
Age*
|
40.6
|
43.7
|
0.017
|
|
Age at Infection*
|
18.4
|
18.9
|
0.656
|
|
Duration of HCV Infection*
|
19.6
|
22.2
|
0.064
|
|
Age at Biopsy*
|
38.5
|
41.6
|
0.015
|
|
Baseline ALT*
|
96
|
116
|
0.193
|
|
HCV Viral Load* (IU/mL)
|
5,801,821
|
2,875,376
|
0.117
|
|
HIV
Viral Load* (n = 23)
|
4807
|
|
|
|
CD4
count* (n = 33)
|
588
|
|
|
|
Stage
of Fibrosis†
|
(%)
|
(%)
|
p value
|
|
0
|
2.6
|
5.0
|
|
|
1
|
51.3
|
35.1
|
|
|
2
|
30.8
|
34.6
|
0.021 +
|
|
3
|
12.8
|
15.6
|
|
|
4
|
2.6
|
9.7
|
|
|
Fibrosis
Stage*
|
1.62
|
1.9
|
|
|
Fibrosis
Index*
|
0.091
|
0.11
|
|
|
*Mean
†
METAVIR system
+
Distribution of fibrosis stages
|
Discussion
Significant differences between the two groups were age at
biopsy (p = 0.015) and age (p = 0.017). The distribution of
stages of fibrosis between the groups was significant (p =
0.021), with co-infected patients having a lower mean stage
of fibrosis.
From other studies it is known that concomitant substance abuse
is a risk factor for progressive HCV-induced fibrosis.
Non-compliance with HAART regimens is a risk factor for worsening
HIV infection.
Inmates are forbidden to use IDU or alcohol and they have regular
medical follow-up. This may account for the more favorable
outcomes in these co-infected patients.
The authors conclude, “These results suggest that abstinence
from substance abuse and adequate medical care in patients
with well controlled HIV infection may positively alter the
natural history of the HCV-HIV co-infected patient.”
04/26/04
Reference
M Pradhan and others. Lower Rates of Histologic Progression
in HCV-HIV Co-Infected Patients Versus HCV-Infected Inmates
in the Louisiana Department of Corrections. Abstract 2038
(poster). Digestive Disease Week. May 15-20, 2004. New Orleans,
LA.
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