Background:  HCV is common among patients that have HIV. HCV progression to cirrhosis is more rapid in co-infection. Hispanic mono-infected patients have been reported to have a high progression to cirrhosis. The objective of this study was to examine the characteristics of a large Hispanic population of co-infected patients, and the variables that affect histologic parameters of progression to cirrhosis.

Methods:  We studied 233 Hispanic, co-infected patients from a single cohort at San Juan, Puerto Rico. All patients were naïve to treatment without other etiology of liver disease. Laboratory and clinical parameters, as well as history of risk of infection, and habits were recorded at time of liver biopsy. All liver biopsies were scored by a single hepato-pathologist, using Ishak (grade 0-18, stage 0-6). FPR was calculated as the ratio of fibrosis score (stage) between estimated duration of infection (years). Multiple statistics, including univariate and multivariate analysis were performed.

Results:  Mean age is 43.21 years (±0.56), mostly male, with mean log HCV 5.68 (±0.07), mean log HIV 3.24 (±0.66), mean CD4 absolute 439.8 (±18.26), mean ALT 99.83 (±6.84), alcohol ingestion 33.13g/day (±5.53). Age at infection mean is 21.73 (±0.58), duration of infection 21.47 (±0.42). Most patients, 72.1%, are non-cirrhotic, with mean grade 7.45 (±0.225), stage 3.08 (±0.115), and FPR 0.15 (±0.006); 52.8% of patients are using PI. In the univariate analysis FPR correlates with risk of infection IDU p = 0.024, increase in ALT p = 0.036, CD4 absolute count <200 p = 0.051, duration of infection (less than 21 years) p = 0.001, age at time of HCV infection p = 0.000, grade p = 0.000, stage p = 0.000. It did not correlate with genotype, alcohol ingestion, HCV viral load, sex, HIV viral load, or HAART. In the multivariate analysis, duration of infection (less than 21 years) p = 0.000 (corrected for all other variables), older age of infection p = 0.008 and Ishak stage p = 0.000 are the only predictors of increased FPR. Treatment with or without PI has no effect on FPR.

Conclusions:  Co-infected Hispanics patients have a rapid progression to cirrhosis. In this population, younger patients with a lower duration of HCV infection have a more rapid FPR. This finding is worrisome, as it suggests a greater risk of cirrhosis in this population, as they grow older. There was no statistically significant impact of HAART (PI or not) in FPR. Therapeutic interventions should be considered with priority in this population.

Keywords: Hispanics; Coinfection; Fibrosis