646-M.
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Factors Associated with Liver Fibrosis in HIV-1 HCV Co-Infected Patients on Antiretroviral Therapy
D. Fuster*, C. Tural, J. Tor, J. Romeu, I. Ojanguren, G. Sirera, R. Muga, Á. Ballesteros, E. Negredo, H. Guardiola, R. Planas, C. Rey-Joly, and B. Clotet
Univ. Autònoma de Barcelona, Spain
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Background: The aim of this study is to elucidate whether factors associated with HAART have any impact on liver fibrosis in HIV/ HCV co-infected patients.
Methods: Cross-sectional study on the factors associated with liver fibrosis in HIV/HCV co-infected patients, naïve for HCV treatment, who underwent percutaneous liver biopsy and were classified in terms of fibrosis according to Knodell classification index. Bivariate and multivariate analyses were used to explore the effects of different characteristics related to HIV/ HCV coinfection on the presence of liver fibrosis .
Results: 157 patients (79.6 % men and 20.4% women, median age 36 [range: 24-60] years) were studied. The median CD4 cell count was 539 (range: 154-1416). 26 patients (17.9%) had a previous AIDS event, 56 (35.6%) had a CD4 nadir <200 cells/ muL, and 118 patients (75.6%) had HIV viral load below 1000 copies/mL. 143 patients (91.1%) were on antiretroviral (ARV) therapy and 97 (61.8%) had been exposed to protease inhibitors (PI). 143 (91.1%) had a HCV plasma viral load below 2,000,000 copies/mL. Knodell stage of fibrosis 3 or 4 was found in 47.8% of patients. Median stage of fibrosis was 1.7 (range: 0-4), median inflammatory grade was 5 (range: 0-14) and median Knodell score was 6 (range: 0-17). 47 patients (29.9%) had no fibrosis (stage 0), 35 (22.3%) had fibrous portal expansion (stage 1), 66 (42.0%) had bridging fibrosis (stage 3), and 9 (5.7%) had cirrhosis (stage 4). The bivariate and multivariate analysis showed that only a CD4+ count below 400 cells/muL was associated with liver fibrosis (OR: 2, 95% CI: 1.06-3.78, p=0.032). No significant association was found between liver fibrosis and immune reconstitution, prior immunosupresion, or antiretroviral exposure.
Conclusion: HAART should be considered and started early in HIV+ patients co-infected with HCV in order to lower liver fibrosis and to confer a better clinical prognosis.
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