Clinical Progression of HCV-related Chronic Liver Disease in HIV Patients Receiving HAART

Little is known about the natural history of liver disease in HIV-HCV coinfected individuals receiving HAART. The objectives of the current study, published in Hepatology (September 2007), were to obtain information about mortality, the incidence of hepatic decompensation, and the predictors of these outcomes in this population.

In this multicenter cohort study, researchers analyzed the time to the first hepatic decompensation and the survival of 1011 antiretroviral-naive, HIV-HCV coinfected patients who started HAART and who were followed prospectively.

Results

• After a median follow-up period of 5.3 years, 59 patients (5.83%) developed a hepatic decompensation and 69 patients (6.82%) died -- 30 (43%) of them due to liver disease.

• The factors independently associated with the occurrence of hepatic decompensation were:

- age older than 33 years;
- female sex;
- Centers for Disease Control and Prevention (CDC) stage C HIV disease;
- diagnosis of liver cirrhosis at baseline;
- CD4 cell gain < 100 cells/mm3;
- less than 60% of follow-up time spent with an undetectable HIV viral load.

• Factors associated with mortality due to liver failure were:

- older age;
- lack of hepatitis C treatment;
- hepatitis D virus coinfection;
- diagnosis of cirrhosis at recruitment;
- hepatic encephalopathy;
- smaller CD4 cell gains.

Conclusion

Based on these findings, the study authors concluded, "End-stage liver disease is the primary cause of death in HIV-HCV coinfected patients under HAART."

In addition, they noted, "Higher increase of CD4 cell counts, lack of markers of serious liver disease, and anti-HCV therapy are factors associated with better hepatic outcome."

09/07/07

Reference
J A Pineda, J A García-García, M Aguilar-Guisado and others. Clinical progression of hepatitis C virus-related chronic liver disease in human immunodeficiency virus-infected patients undergoing highly active antiretroviral therapy. Hepatology 46(3): 622-630. July 20, 2007 [Epub ahead of print].