Advanced Liver Disease among HIV-HCV Coinfected Individuals

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Advanced Liver Disease among HIV-HCV Coinfected IndividualsBy Liz Highleyman

Studies to date have produced conflicting data about the incidence of liver fibrosis progression in HIV-HCV coinfected individuals, whether this is more rapid in coinfected compared with HCV monoinfected patients, and how chronic liver disease is affected by antiretroviral therapy.

In a study presented at the 14th Conference on Retroviruses and Opportunistic Infections last month in Los Angeles, researchers assessed the incidence and characteristics of advanced end-stage liver disease -- or hepatic decompensation -- and liver-related mortality in HIV-HCV coinfected patients receiving HAART. The study included 1011 previously antiretroviral-naive coinfected participants who started HAART at 5 hospitals in Spain.

Results

After a median follow-up period of about of 5 years, 59 patients (5.83%) developed hepatic decompensation and 69 (6.82%) died (1.36 per 100 person-years).

Of the 69 total deaths, 30 (43%) were due to liver disease, 15 (22%) were due to AIDS, and 24 (35%) were due to other causes.

39 of 953 patients (4.09%) without liver cirrhosis at baseline developed hepatic decompensation, 20 of whom (2.1%) died due to liver failure. Categorized according to CD4 cell gain after starting HAART, the rates of liver decompensation were:

+ > 300 cells/mm3: 14 (2.76%) decompensations, 7 (1.38%) liver-related deaths; + 100-300 cells/mm3: 11 (3.55%) decompensations, 6 (1.94%) liver-related deaths; + < 100 cells/mm3: 14 (7.14%) decompensations, 7 (3.57%) liver-related deaths.

The most common presentation of decompensated liver disease was ascites (abdominal fluid accumulation), followed by hepatic encephalopathy and jaundice.

Factors independently associated with the development of hepatic decompensation were:

age older than 33 years; female sex; CDC stage C HIV disease; baseline cirrhosis; CD4 cell gain of less than 100 cells/mm3; less than 60% of follow-up time spent with undetectable HIV viral load.

Factors associated with death due to liver failure were:

older age; smaller CD4 cell gain;

lack of anti-HCV treatment;

coinfection with hepatitis delta virus (HDV); baseline cirrhosis; hepatic encephalopathy.

Conclusion

“The overall rate of clinical progression of liver disease in HIV-HCV [co]infected patients under HAART is relatively low,” the investigators concluded. “In spite of that, end stage liver disease is the main cause of death in this population.”

Hosp Univ de Valme, Seville, Spain; Hosp Univ Virgen del Rocio, Seville, Spain; Hosp Univ Virgen de la Macarena, Seville, Spain; Hosp Virgen de la , Malaga, Spain; Hosp Univ Reina Sofía, Cordoba, Spain.

PDF of poster

Link to study abstract

03/30/07

ReferenceJ A García-García, M Aguilar-Guisado, M Ríos-Villegas, and others (Grupo Andaluz para el Estudio de las Enfermedades Infecciosas). Clinical Progression of Hepatitis C Virus-related Chronic Liver Disease in HIV-infected Patients Undergoing HAART. 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, February 25-28, 2007. Abstract 934 (poster).

http://www.hivandhepatitis.com/2007icr/croi/docs/033007_g.html