Background:  HAART hepatotoxicity could enhance liver fibrosis in HIV/HCV-co-infected patients. Moreover, HAART-related immune restoration could lessen HCV-associated liver damage. The data on the effect of protease inhibitors (PI) on liver fibrosis are scant and contradictory. No information is available on the relationship between non-nucleoside analog therapy and liver fibrosis in co-infected patients. Our objective was to investigate through cross-sectional study the associations between the use of different antiretroviral drugs and the liver fibrosis in patients with HIV and HCV infections.

Methods:  All HIV/HCV-co-infected patients with an available liver biopsy and known or estimated duration of HCV infection seen at a Infectious Diseases Unit were included in the study. The fibrosis stage and the fibrosis progression rate were evaluated. Variables that could be associated with liver fibrosis were considered in the analysis: Age at infection, age at LB, duration of HCV infection, sex, alcohol intake, route of HCV transmission, CD4⁺ cell counts at LB, nadir of CD4⁺ cell counts, clinical AIDS, ALT levels at LB, HCV genotype and serum RNA levels, use of individual antiretroviral drugs at any time before LB and the duration of exposure to each of them. The variables associated with the stage of fibrosis and with fibrosis progression were included in a stepwise logistic regression model.

Results:  The inclusion criteria were fulfilled by 152 patients. Age at HCV infection <20 years (adjusted odds ratio [AOR] 0.39, 95%CI:  0.19 to 0.82), PI-based HAART (AOR 0.39, 95%CI:  0.19 to 0.78) and nevirapine-based HAART (AOR 2.56, 95%CI 1.02 to 6.58) were associated with fibrosis stage ≥F3. The variables associated with fibrosis progression rate >0.2 units/year were age at HCV infection <20 years (AOR 0.23, 95%CI:  0.1 to 0.52), CD4⁺ cell counts ≤250/mL at liver biopsy (AOR 2.8, 95%CI:  1.1 to 7.1), PI-based HAART (AOR 0.39, 95%CI:  0.2 to 0.8) and nevirapine-based HAART (AOR 3.82, 95%CI:  1.9 to 7.6).

Conclusions:  HAART regimens including nevirapine are associated with faster liver fibrosis progression in HIV-infected patients with chronic hepatitis C. To the contrary, patients on PI as backbone of potent antiretroviral therapy are more likely to show less liver fibrosis.

Keywords: liver fibrosis; HAART; HCV infection