Prevalence and Outcomes of Liver Cirrhosis in HIV Positive People

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By Liz Highleyman

As people with HIV live longer and are less likely to die of AIDS-defining illnesses, end-stage liver disease has become an increasingly important cause of morbidity and mortality in this population.

Advanced liver disease in HIV positive people may be caused or exacerbated by a variety of factors, including chronic hepatitis B or C virus infection, heavy alcohol use, or hepatotoxic antiretroviral drugs.

As reported in the March 2008 Journal of Viral Hepatitis, Spanish researchers conducted a retrospective, observational, cross-sectional study to assess the prevalence of liver cirrhosis, its main causes, and its clinical presentation in all HIV positive individuals followed at a single HIV outpatient clinic in Madrid.

Liver fibrosis was measured using the non-invasive transient elastometry method (FibroScan). All 2168 HIV positive patients receiving regular follow-up at the clinic underwent elastometry between October 2004 and August 2006. About three-quarters (76%) were men and about half (46%) were injection drug users.

Results

• 181 patients were identified as having liver cirrhosis, for an overall prevalence rate of 8.3%.
•
The major causes associated with cirrhosis were:
- Hepatitis C virus (HCV): 82.3%;
- Hepatitis B virus (HBV): 1.6%;
- Dual HBV/HCV infection: 2.8%;
- Triple HBV/HCV/hepatitis delta virus (HDV) infection: 6.6%.

• The prevalence of cirrhosis differed among patients with distinct types of chronic viral hepatitis:
- HCV: 19.2%;
- HBV: 6.1%;
- HBV/HCV: 41.7%;
- HBV/HCV/HDV: 66.7%.

• In 12 patients with cirrhosis (6.7%), no definite etiology was identified.

• Overall, patients with cirrhosis had a lower mean CD4 cell count than those without cirrhosis (408 vs 528 cells/mm3, respectively; P = 0.02).

• However, similar proportion of cirrhotic and non-cirrhotic patients had undetectable HIV viral load on HAART.

• Observed clinical manifestations of liver cirrhosis included:
- Splenomegaly (enlarged spleen): 61.5%;
- Esophageal varices: 59.8%;
- Ascites: 22.6%;
- Encephalopathy: 12.1%;
- Variceal bleeding: 6.1%.

Conclusion

Based on these findings, the investigators concluded, "Liver cirrhosis and hepatic decompensation events are relatively frequent in HIV positive individuals."

In this study, they continued, "Chronic HCV and alcohol abuse, but not chronic HBV, play[ed] a major role."

Finally, they concluded that, "Transient elastometry may allow the identification of a significant number of HIV positive individuals with asymptomatic liver cirrhosis."

4/11/08

Reference
C Castellares, P Barreiro, L Martin-Carbonero, and others. Liver cirrhosis in HIV-infected patients: prevalence, aetiology and clinical outcome. Journal of Viral Hepatitis 15(3): 165-172. March 2008.