830 Histological Damage in Liver Biopsy Specimens from 492 HIV-HCV Co-infected Patients: A European Collaborative Study L. Martin-Carbonero*1, V. Soriano1, Y. Benhamou2, M. Puoti3, J. Rockstroh4, A. Arizcorreta5, J.A. Giron5, V. Asensi6, A. González7, M. Vogel4, J. Garcia-Samaniego1 1Inst de Salud Carlos III, Madrid, Spain; 2Hosp Pitié Salpêtrière, Paris, France; 3Spedali Civili, Brescia, Italy; 4Univ Hosp Bonn, Germany; 5Hosp Puerta del Mar, Cadiz, Spain; 6Hosp Gen Oviedo, Spain; and 7Ctrs Penitenciarios, Madrid, Spain
Background: HCV-related liver damage progresses faster in HIV co-infected patients (pts) than in HIV-negative individuals. In HCV mono-infected patients with elevated ALT levels 51% and 24% have no (F0) or just portal fibrosis (F1), respectively; whereas portal fibrosis with septa (F2), many septa (F3), or cirrhosis (F4) is recognized in 9.9%, 9.7% and 5.3%, respectively, but this information is not well known for HIV-positives.
Methods: All participants were invited to fill a case report form in which the main demographics, clinical, laboratory, and histological findings from HIV-HCV co-infected patients with elevated ALT levels were recorded. The liver biopsy had been performed in all instances to assess the indication for anti-HCV treatment.
Results: We analyzed 492 pts: 78.5% were male; 86% had been IDUs; and 25% admitted high alcohol intake (> 80 g/d). Median age was 35 yrs (IQ 31-39). Median estimated duration of HCV infection was 14 yrs (IQ 10-18). Median CD4 count was 463 cells/ul (IQ 300-630). Median ALT elevation was 2-fold (IQ 1-4 fold). Antiretroviral therapy: HAART in 32%, mono or dual tx 22.5%, and no drugs 57%. HCV genotype was 1 (57%), 2 (1%), 3 (36%), and 4 (6.3%). Up to 69% of pts harbored > 800,000 IU/ml. Liver fibrosis stage was F0 (13.2%), F1 (35%), F2 (18.7%), F3 (21.5%), and F4 (12%). In the multivariate logistic regression analysis, 3 factors were the best predictors of severe liver fibrosis (F3-F4): duration of HCV infection > 15 yrs (OR 3.6; CI 95%, 1.5-4.4); age > 20 yrs at the time of HCV infection (OR 3.3; CI 95%, 1.9-5.6); and history of high alcohol intake (OR 2.5; CI 95%, 1.5-4.4). Pts estimated to be infected for more than 15 yrs had severe liver fibrosis in 46% of cases. Severe liver fibrosis was not associated with the CD4 count, HCV genotype, HCV viremia, gender, or use of HAART.
Conclusions: More advanced stages of liver fibrosis are seen in HIV-HCV co-infected pts than in HCV-mono-infected pts. Overall, up to 1/3 of those with elevated ALT levels show severe liver fibrosis (F3-F4), but increases significantly with duration of HCV infection mounting up to 50% after 15 yrs of carrying HCV. Thus, treatment of HCV infection should be not delayed unnecessarily given that lower response rates are seen in cirrhotics.