Factors influencing liver fibrosis and necroinflammation in HIV/HCV coinfection and HCV monoinfection

Infection. 2013 Oct;41(5):959-67. doi: 10.1007/s15010-013-0502-3. Epub 2013 Jul 10.

Abstract

Objectives: To define differences in liver histology between HIV/HCV coinfection and HCV monoinfection, and to investigate possible causative factors.

Methods: Liver biopsies (LBs) from 440 consecutive HIV/HCV-coinfected patients (Group HIV/HCV) and 374 consecutive HCV-monoinfected patients (Group HCV) were evaluated for necroinflammation and fibrosis (Ishak) by a pathologist unaware of the clinical and laboratory data. All patients were HBsAg-negative, with no history of alcohol abuse and naïve to anti-HCV treatment. At LB, 78.4% of patients in Group HIV/HCV were on an antiretroviral regimen.

Results: HIV/HCV-coinfected patients compared to the HCV-monoinfected patients were younger (p < 0.0001), more frequently males (p < 0.0001), and had HCV genotype 3 (p < 0.0001); they showed a good immunological condition (CD4+ cell count: 518 ± 166 cells/mm(3)). Patients in Group HIV/HCV more frequently showed a fibrosis score ≥4 (27.5 vs. 20.6%, p < 0.05) and a necroinflammation score ≥9 (25.9 vs. 13.4%; p < 0.0001). The prevalence of patients with fibrosis score ≥4 was significantly higher in older age classes in both Group HIV/HCV (p < 0.005) and Group HCV (p < 0.05). A necroinflammation score ≥9 was significantly higher in older age classes only in Group HIV/HCV (p < 0.05). A multivariate analysis for Group HIV/HCV revealed that the patient age and nadir of CD4+ cell count were independently associated to higher degrees of fibrosis, the patient age and antiretroviral treatment were associated to higher degrees of necroinflammation, and HCV genotype 3 was associated to higher degrees of steatosis.

Conclusion: The data suggest a need for early anti-HCV treatment in both HCV-monoinfected and HIV/HCV-coinfected patients.

MeSH terms

  • Adult
  • Chi-Square Distribution
  • Coinfection / pathology*
  • Coinfection / virology*
  • Female
  • Genotype
  • HIV / isolation & purification
  • HIV Infections / pathology*
  • HIV Infections / virology
  • Hepacivirus / genetics
  • Hepacivirus / isolation & purification
  • Hepatitis C / pathology*
  • Hepatitis C / virology
  • Humans
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology*
  • Male
  • Middle Aged
  • Necrosis / pathology
  • Necrosis / virology
  • Prevalence