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and Hepatitis.com Coverage of the
17th Conference on Retroviruses and
Opportunistic Infections (CROI 2010)
February 16 - 19, San Franciso, California
Does Liver Fibrosis Progress Faster in People Who Have HIV When They Acquire Hepatitis C?
The natural history of liver disease progression in individuals who already have HIV when they acquire HCV is not fully understood. Daniel Fierer's group at Mt. Sinai School of Medicine in New York has reported alarming levels of fibrosis in men coinfected for only a short time. European investigators, however, have not observed a similar phenomenon.
Martin Vogel and fellow investigators with the NEAT Study Group prospectively evaluated liver fibrosis progression among HIV positive patients with acute hepatitis C.
The researchers estimated extent of fibrosis using the transient elastometry method (FibroScan), which measures liver "stiffness." They used the following stiffness value cut-offs as equivalents of Metavir fibrosis scores:
assumed that patients had stage F0 (absent fibrosis) prior to acute
hepatitis C, unless available FibroScan or liver biopsy results indicated
otherwise. Fibrosis progression rate was calculated by dividing the
difference in fibrosis units by the duration of follow-up time.
"Calculated high fibrosis progression rates after acute HCV infection in HIV-positive individuals are probably influenced by short observation periods," the NEAT investigators concluded.
"Higher liver stiffness in the acute phase of HCV infection may be at least partially explained by higher inflammatory activity which has been shown to increase stiffness leading to overestimation of fibrosis," they continued.
Finally, they advised, "A linear model for fibrosis progression, as is currently applied in the setting of chronic HCV infection, should be used with caution in the setting of acute HCV infection."
There is controversy over whether FibroScan is accurate enough to track fibrosis progression. While it performs well at distinguishing mild versus severe liver disease, it is not as good at distinguishing between intermediate stages.
Of note, the Mt. Sinai team's findings are based on liver biopsies, which are still considered the "gold standard" for diagnosing and staging liver disease.
University of Bonn, Germany; Chelsea and Westminster Hospital, London, UK; Practice Mauss/Schmutz/Hegener/Athmann, Düsseldorf, Germany; Practice Dupke/Baumgarten/Carganico, Berlin, Germany.