HIV and Hepatitis.com Coverage of the
42nd EASL Conference
April 11 - 15, 2007, Barcelona, Spain
THE EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER

HIV-HCV Coinfected Patients with Normal CD4 Counts Do Not Have More Rapid Liver Fibrosis Progression

By Liz Highleyman

Several past studies (mostly retrospective) have indicated that HIV-HCV coinfected patients appear to experience more rapid liver disease progression than HCV monoinfected individuals. But others have shown that this may not be the case for coinfected patients with well-preserved immune function, as indicated by high CD4 cell counts.

As presented at the 42nd Annual Meeting of the European Association for the Study of the Liver this week in Barcelona, Spain, French researchers conducted a prospective study to compare liver fibrosis, fibrogenesis, and fibrosis progression rates, as well as intrahepatic and peripheral blood HCV-specific and non-specific immune responses, in HIV-HCV coinfected and HCV monoinfected patients.

The study included 33 HIV-HCV coinfected participants with CD4 cell counts greater than 250 cells/mm3 and 33 subjects with HCV alone. Patients were included if they had an indication for liver biopsy, a known duration of HCV infection, no other potential causes of liver disease, and had not received hepatitis C treatment. Baseline characteristics (age, sex, duration of HCV infection) were similar in the 2 groups.

Fibrosis was assessed using the Ishak system and fibrogenesis was assessed using alpha smooth muscle cell actin (a-SMA) immunostaining. The fibrosis progression rate was calculated as the ratio of the fibrosis score over the duration of HCV infection.

Results

  • HIV-HCV coinfected and HCV monoinfected patients had similar indicators of fibrosis:
    • Ishak score: 2.69 vs 2.72, respectively;
    • a-SMA score: 4.7 vs 4.6;
    • fibrosis progression rate: 0.08 in both groups.
  • The frequency and magnitude of HCV-specific immune responses in peripheral blood-derived cell lines were also similar in the coinfected and monoinfected patients:
    • detection of specific responses: 88% vs 71%, respectively;
    • magnitude: 163 vs 182 SFC/106 cells, respectively.
  • Regardless of HIV infection status, the fibrosis progression rate was inversely correlated with the poly-specificity and magnitude of peripheral blood HCV-specific responses.
  • The fibrosis progression rate was positively correlated with IL-4 and IL-10 levels under non-specific stimulation.

Conclusion

In conclusion, the investigators wrote, “HIV patients with normal CD4 count[s] do not have a worse progression of fibrosis compared to HCV monoinfected patients. Moreover, their HCV specific immune response is not impaired.”

AP-HP Jean Verdier Hospital, Bondy, France; EA 3406, Paris 13 University, Bobigny, France; INSERM U567, Paris, France; AP-HP Avicenne Hospital, Bobigny, France; AP-HP Henri Mondor Hospital, Creteil, France.

04/13/07

Reference  
M Ziol, M Andrieu, N Barget, and others. HIV-HCV Coinfected patients with normal CD4 count do not have a more rapid progression of fibrosis than HCV monoinfected patients. 42nd Annual Meeting of the European Association for the Study of the Liver. April 11 - 15, 2007, Barcelona, Spain.


 





























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