Several
studies have indicated that liver fibrosis progresses more rapidly in HIV-HCV
coinfected people compared to those with hepatitis
C alone. Among HCV monoinfected individuals, fibrosis
progresses more slowly in those with normal alanine aminotransferase (ALT)
levels, but this association has not been well studied in the setting of HIV-HCV
coinfection.
In a study presented at the 15th Conference
on Retroviruses and Opportunistic Infections this week in Boston, European
researchers used elastometry (FibroScan) to compare the degree of fibrosis in
448 HCV monoinfected and 118 HIV-HCV coinfected patients with detectable serum
HCV RNA and persistently normal ALT at clinics in France, Italy, and Spain; none
had received hepatitis C treatment.
Persistently normal ALT was defined
as below the upper limit of normal on at least 3 consecutive tests within the
past 12 months. Liver fibrosis stage was defined as mild (Metavir stage F0-F2)
if the elastography score was < 9.5 kiloPascals (kPa), moderate (F3)
if 9.5 to 12.5 kPa, and severe (F4) if > 12.5 kPa.
Results
•
At baseline, the HCV monoinfected study participants
were, on average, older (52 vs 43 years), more likely to be female (63% vs 37%),
and less likely to report drinking more than 40g/day alcohol (18% vs 26%) than
the coinfected patients.
•
Mean serum HCV RNA levels were similar in
both groups (5.9 vs 5.8 log IU/mL).
•
HCV genotype distribution, however, differed
in the HCV monoinfected and coinfected patients:
•
Genotype 1: 55% vs 52%; •
Genotype 2: 23% vs 4%; •
Genotype 3: 6% vs 11%; •
Genotype 4: 14% vs 32%.
•
Among the HIV positive patients, 78.6% were
on HAART and the mean CD4 count was 518 cells/mm3.
•
Distributions of liver fibrosis scores in
the HCV monoinfected and HIV-HCV coinfected groups were:
•
Mild: 93% vs 91%; •
Moderate: 3% vs 4%; •
o Severe: 3% vs 5%.
•
In univariate and multivariate logistic regression
analyses, the only factor associated with having moderate or severe (compared
with mild) fibrosis was older age (OR 1.04; P < 0.001).
•
After adjusting for age, however, HIV-HCV
coinfected patients tended to have moderate to severe liver fibrosis more often
than HCV monoinfected individuals (OR 2.2; P = 0.06).
Conclusion
Based
on these findings, the investigators concluded, "Nearly 10% of HIV-HCV coinfected
patients with persistently normal ALT have moderate to severe liver fibrosis (Metavir
F3 to F4), which is seen in only 7% of HCV monoinfected patients. After adjusting
for age, HIV positive patients with persistently normal ALT tend to show more
advanced liver fibrosis."
Hosp
Carlos III, Madrid, Spain; Haut-Leveque Hosp, Bordeaux, France; Univ of Sassari,
Italy.
2/5/08
Reference L
Martin-Carbonero, V de Ledinghen, A Moreno, and others. Liver Fibrosis in Chronic
Hepatitis C Patients with Persistently Normal Aminotransferases: Effect of HIV
Infection. CROI 2008. Boston, MA. February 3-6, 2008. Abstract 1052.
Fibrosis
Status of HIV-HCV Coinfection Patients with Normal ALT Levels
Several
studies have indicated that liver fibrosis progresses more rapidly in 
