HIV and Hepatitis.com Coverage of the
14th Annual Conference on Retroviruses
and Opportunistic Infections (14th CROI)
February 25 - 28, 2007, Los Angeles, CA
Antiretroviral Therapy Reduces Liver Fibrosis Progression in HIV-HCV Coinfected Patients


By Liz Highleyman

Past research has shown that liver disease due to hepatitis C virus (HCV) infection tends to progress more rapidly in HIV positive compared with HIV-negative individuals, but the reasons are not well understood. In addition, there are conflicting data on the influence of antiretroviral therapy on liver fibrosis progression.

As reported at the 14th Conference on Retroviruses and Opportunistic Infections last month in Los Angeles, researchers from Hospital Gregorio Maranon in Madrid, Spain, performed liver biopsies on 296 HIV-HCV coinfected patients who had not received treatment for hepatitis C. For the present study, they analyzed data from 213 patients (80% men) who presumably acquired HIV via injection drug use, and for whom the date of HCV infection could be ascertained.

At the time of biopsy, the median age was 39 years, the median CD4 count was 460 cells/mm3, and 72.8% of patients had an HIV viral load below 50 copies/mL. The estimated median time since HCV infection was 21.3 years, 57.4% had genotype 1 HCV, and 13.7% reported high alcohol consumption. Based on this estimate, patients had been off HAART for about 17 years and on HAART for about 4 years since HCV infection.

The researchers used logistic regression analysis to assess the association between time on HAART and a fibrosis progression index (FPI), defined as the ratio of fibrosis stage to years of HCV infection, as well as the association between  time on HAART and fibrosis stage. Liver fibrosis was scored using the METAVIR system (stages F0 to F4).

Results

  • The distribution of liver fibrosis was as follows:

    • Stage F0: 0.5%;
    • Stage F1: 37.1%;
    • Stage F2: 31.9%;
    • Stage F3 (bridging fibrosis): 18.8%;
    • Stage F4 (cirrhosis): 11.7%.

  • The risk of having an FPI of 0.1 or less increased with additional time on HAART (adjusted OR 1.24 per additional month).

  • The odds of having stage F0/F1 vs stage F3/F4 fibrosis increased by a similar amount per additional month on HAART, as did the odds of having stage F2 vs F3/F4 fibrosis (adjusted OR 1.24 and 1.22, respectively).
Conclusion

The investigators concluded that, “Our results show that HAART reduces the fibrosis progression rate and the development of bridging fibrosis and cirrhosis in HIV-HCV coinfected patients.”

Link to poster 

Link to study abstract

03/20/07

References
S Resino, J Berenguer, P Miralles, and others. HAART Reduces the Fibrosis Progression Rate and the Development of Bridging Fibrosis and Cirrhosis in HIV/HCV-co-infected Patients. 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, February 25-28, 2007. Abstract 935 (poster).













































14th croi