Liver Fibrosis Rates Are High among HIV-monoinfected, HIV-HBV- and HIV-HCV-coinfected Patients

By Brian Boyle, MD

Limited data are available that define the prevalence of significant liver fibrosis among HIV-infected patients without viral hepatitis and among coinfected patients not referred to liver clinics. Investigators at Johns Hopkins estimated the prevalence of significant fibrosis in this population using the AST to platelet ratio index (APRI) which has been validated in HIV-infected patients.  

The investigators evaluated markers of liver fibrosis in 4052 patients followed in the Johns Hopkins HIV clinic who had complete data available. They determined the prevalence of significant hepatic fibrosis (Ishak stage ·F3) according to APRI (AST /ULN)*100/platelet count.) and used univariate and multivariate analyses to find associations with significant fibrosis in these patients.

The population studied had the following characteristics:  male 67%; black 76%; age >35 years, 64%; active or past alcohol abuse, 27%; active or past injection drug use, 44%; weight, 71 kg; no current ART, 72%; hepatitis C virus (HCV) antibody+, 42%, HBsAg+, 9%; CD4 >200 cells/mm3, 55%; HIV RNA <400 copies/mL, 27%; glucose >140 mg/dL, 6.3%.

The prevalence of significant fibrosis (APRI >1.5) was 7.4% in patients with HIV only, 21.3% in HIV/HCV patients, 22% in HIV/HBV patients and 38.7% in HIV/HC/HBV infected patients. By multivariate analysis, significant fibrosis was independently associated with (AOR, 95% CI):  black race (0.74, 0.55 to 1.0); alcohol abuse (1.6, 1.4 to 2.3); CD4 >50 cells/mm3 (0.31, 0.3 to 0.4); current ART (1.41, 1.0 to 1.95); glucose >140 mg/dL (2.5, 1.8 to 3.4); chronic HBV (2.7, 2.0 to 3.6); chronic HCV (2.9, 2.4 to 3.6).

The authors conclude, “Consistent with estimates derived from liver biopsy cohorts, the prevalence of significant fibrosis by APRI was relatively high among patients with chronic viral hepatitis, particularly among those tri-infected with [HIV + HBV + HCV]. Additionally, ~7% of patients with HIV alone had significant fibrosis, indicating that research is needed to define the prevalence and histologic features (e.g., steatosis) of liver disease in HIV-mono-infected patients in the era of effective ART. These data also suggest that strategies to prevent liver disease (e.g., HCV- or HBV-treatment and alcohol cessation) should be implemented in similar settings.”

02/14/06

Reference
M S Sulkowski and others. Estimated Prevalence of Significant Liver Disease among 4052 HIV-infected Adults with and without Chronic Hepatitis B and C. 13^th Conference on Retroviruses and Opportunistic Infections. Denver, CO. February 5-8, 2006. Abstract 842.