Predictors of Advanced Liver Fibrosis in an Urban Cohort of HIV-HCV Coinfected Patients

Due to overlapping transmission routes, many people are coinfected with both HIV and hepatitis C virus (HCV), especially those who have a history of injection drug use. Long-term chronic hepatitis C can lead to advanced liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC).

As reported at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy this week in Chicago, researchers retrospectively assessed factors that predicted advanced fibrosis in a large cohort of patients at Chicago's Cook County Hospital. Out of more than 4500 HIV positive patients seen at the CORE Center HIV clinic, 30% are coinfected with HCV, but treatment for chronic hepatitis C is uncommon.

The investigators estimated liver fibrosis progression using the AST-to-platelet ratio index (APRI). An APRI score < 0.5 is used to exclude significant fibrosis, while an APRI score > 1.5 is a good surrogate for advanced fibrosis on liver biopsy. The aim of this study was to identify predictors of an APRI score > 1.5, and thus identify patients who need HCC screening and urgent referral for treatment evaluation.

Results

• Among the 1275 HIV-HCV coinfected patients at the CORE Center, the mean age was 47 years, 76% were men, 76% were African American, 11% were Caucasian, and 11% were Hispanic.

• The median CD4 cell count was 273 cells/mm3 (36% with < 200 cells/mm3; 27% with 200-350 cells/mm3, and 36% with > 350 cells/mm3).

• 43% had undetectable HIV viral load.

• 10.5% had diabetes mellitus.

• The median APRI score was 0.21.

• 81% had an APRI score < 0.5 and 5.5% had a score > 1.5.

• Patients with an APRI score > 1.5 were more likely to be Hispanic, more likely to have diabetes (17% vs 10%), had a lower average CD4 count (191 vs 328 cells/mm3) and were less likely to have undetectable HIV RNA (28% vs 44%).

• In a multivariate analysis, predictors of an APRI score > 1.5 were a CD4 count ? 200 cells/mm3 (OR 4.52) and Hispanic ethnicity (OR 2.61).

• When modeled as a continuous variable, each CD4 count increase of 10 cells/mm3 reduced the odds of having an APRI score > 1.5 by 31% after adjusting for Hispanic ethnicity.

Conclusion

"In this large cohort of HIV/HCV coinfected patients, approximately 20% had been evaluated for HCV treatment," the authors wrote. "Using APRI as a marker for advanced fibrosis, 70 patients (5.5%) were predicted to have advanced disease; on multivariate analysis, risk factors were Hispanic race and lower CD4 counts."

"The low rate of predicted advanced fibrosis may be due to use of HAART, as over 60% of the patients had [a] CD4 [count] > 200 and 66% had HIV RNA < 5000, with 43% being undetectable," they continued. "These data support others that suggest that Hispanic patients and patients with low CD4 count have an increased risk of fibrosis."

Cook County Hospital, Chicago, IL; Rush University Med. Ctr., Chicago, IL; UIC Med. Ctr., Chicago, IL.

09/21//07

Reference
O Adeyemi, B Hota, S Colter. Advanced Fibrosis in a Large Cohort of HIV/HCV Co-Infected Patients (pts): Predictors in a Large Urban Cohort. 47th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, September 17-20, 2007. Abstract V-1899.