HIV
Positive People without Viral Hepatitis or Other Risk Factors Have a Fibrosis
Distribution Similar to the General Population
 | People
with HIV who do not have hepatitis B or C coinfection or other recognized liver
disease risk factors such as heavy alcohol use are about as likely to have liver
fibrosis as the HIV negative general population, according to a poster presented
at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment,
and Prevention (IAS 2009) last month in Cape Town, South Africa. |
By
Liz Highleyman It
is well known that liver fibrosis is common among HIV positive individuals with
concurrent hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and studies
indicate that coinfection
is associated with accelerated fibrosis progression. But the prevalence and
extent of liver fibrosis among HIV positive people without these and other known
liver disease risk factors has not been extensively studied. In
the present study, Italian researchers prospectively assessed liver fibrosis in
HIV positive patients without overt causes of liver disease and examined potential
factors that may influence liver disease activity. Liver
fibrosis was assessed using transient elastography (FibroScan), a non-invasive
method that uses sound waves to measure liver "stiffness" (expressed
in kilopascals, or kPa). The investigators looked at all consecutive HIV positive
patients without an evident cause of liver disease who attended their institution
in Florence between September 2007 and December 2008. A
total of 175 patients were included, mostly (85%) men with a mean age of 45 years.
Most (87%) were receiving combination antiretroviral therapy (with an average
duration of 6.3 years), the mean CD4 cell count was 417 cells/mm3, and 65% had
HIV RNA < 50 copies/mL. The mean alanine (ALT) and aspartate (AST) transaminase
levels were 31 and 27 IU/L, respectively, and 21% had metabolic syndrome (according
to NCEP criteria). FibroScan
results were interpreted on the basis of Metavir score, estimating absent or mild
fibrosis (score F0-F1) when liver stiffness was < 7.1 kPa, and fibrosis
or cirrhosis (F2-F4) when stiffness was > 7.1 kPa. Clinical, biochemical, and
behavioral factors were correlated with liver stiffness using univariate and multivariate
analyses. Results  | The
mean liver stiffness value was a low 5.7 kPa (score F0). | | Overall,
23 patients (13%) had scores indicating significant liver fibrosis (F2-F4), similar
to rates seen in general population studies. | | In
a univariate analysis, sex, liver enzyme levels, and all parameters included in
the metabolic syndrome (e.g., high blood pressure, insulin resistance, abdominal
obesity) were associated with liver stiffness. | | There
was no significant association, however, between liver stiffness and patient age,
transmission risk practices (60% were men who have sex with men), CD4 count, HIV
viral load, specific antiretroviral drug regimen or cumulative duration on ART. | | In
a multivariate analysis, significant liver fibrosis was independently associated
with AST and ALT levels and metabolic syndrome. |
Based
on these findings, the investigators concluded that HIV positive patients without
overt causes of liver disease show a spread of liver fibrosis that does not differ
from that of the general population as described in the medical literature. S.M.
Annunziata Hospital, Infectious Diseases, Firenze, Italy. 8/7/09 Reference
N
Marino and F Mazzotta. Liver fibrosis assessment in a cohort of HIV positive patients
without overt cause of liver disease. 5th International AIDS Society Conference
on HIV Pathogenesis, Treatment, and Prevention (IAS 2009). July 19-22, 2009. Cape
Town, South Africa. Abstract WePeB221.
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