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Histological Damage of Hepatitis C Virus in HIV-Infected Patients J. TOR*, C. TURAL, I. OJANGUREN, J. ROMEU, D. FUSTER, C. ROVIRA, G. SIRERA, J. A. JIMENEZ, R. MUGA, C. REY-JOLY, and B. CLOTET.
IRSI-Caixa Fndn.. Hosp., Univ. Germans Trias i Pujol.; and Univ. Autònoma de Barcelona, Spain Objectives: 1) To study if patients with hepatitis C virus (HCV) and HIV coinfection have a worse histologycal status than those with hepatitis C alone; 2) to evaluate the correlation of the histologycal status with enzymatic levels, CD4 counts and HIV and HCV viral loads in HIV infected patients.
Methods: We evaluated 162 cases with HCV infection, 105 HIV and HCV coinfected patients on HAART and stabilized HIV disease, and 57 age-related HIV seronegative controls (age 2 years) with HCV infection. All subjects underwent a percutaneous hepatic biopsy and were classified in terms of degree of inflammation (from 0 to 18 degrees) and fibrosis (from 0 to 4 degrees), according to Knodell and Desmet’s classification index. The histologycal classification was compared with HIV status, enzymatic levels, previous and at biopsy time CD4 counts and viral loads of HIV and HCV.
Results: In 161 out of 162 patients (99.4%) liver biopsies showed chronic hepatitis with different degrees of fibrosis and additionally cirrhosis was demonstrated in 13 of them (8%). Frequency of chronic hepatitis and cirrhosis was similar in cases and controls. In patients with chronic hepatitis, the mean inflammation index was 4.772.7 for the group with HCV and HIV coinfection and 5.42.5 for the group with HCV alone (p=0.115). In HIV-infected patients ALT and AST levels, CD4 counts and HCV or HIV viral loads were not related to hepatic inflammation at the time of biopsy. However, AST and ALT levels and at least a previous CD4 count below 200 cells/l were correlated with the degree of hepatic fibrosis.
Conclusions: Patients coinfected with HCV and HIV showed a similar hepatic damage than age-related subjects with chronic HCV infection alone. The inflammatory changes or fibrosis were not related to CD4 counts or HIV and VHC viral loads at biopsy intervention, whereas the presence of previous immunodepression, ALT and ASL levels were correlated with the degree of hepatic fibrosis.
Key Words: Coinfection, HCV, Liver disease
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