Background:  Current guidelines suggest that hepatitis C virus (HCV) treatment may be deferred in persons with minimal fibrosis. To assess the applicability of this recommendation to HIV-infected persons, we prospectively examined the change in fibrosis stage between paired liver biopsies (bx) among HIV/HCV-co-infected patients attending an urban HIV clinic    

Methods:  A total of 67 patients underwent 2 bx. Paired bx were simultaneously evaluated by a single pathologist blinded to bx sequence and scored according to the Ishak criteria from F0 (no fibrosis) to F6 (cirrhosis). Logistic regression analysis was used to identify non-histological and histological correlates of progression of fibrosis (≥ 2 stages). 

Results:  Of the 67 patients, 6 were excluded due to cirrhosis on the first bx. Characteristics at first bx included:  median age, 44 years; male, 75%; black, 86%; CD4 < 200/mm³, 21%; HIV RNA < 400 copies/mL, 57%; ART, 86%; alcohol abuse, 27%; persistently elevated AST, 31%; no steatosis, 68%. Median time between bx was 2.84 years (IQR, 2.05 to 3.41 years). Fibrosis increase ≥ 2 stages was observed in 17 (28%) of patients whereas a 1-stage decrease occurred in only 4 (7%) patients (all F1 at first bx). Among persons with mild fibrosis (≤ F1) at first bx, 26% (95% CI 14 to 44%) had evidence of 2-stage progression. Compared with those with no progression, patients with a 2-stage fibrosis increase were more likely to have elevated HIV RNA > 10,000 copies/mL at bx 1(26% > 6%, p = 0.03) and persistently elevated AST levels at bx 1 (44% > 12%, p = 0.01) and between bx (47% > 18%, p = 0.02). No significant association was detected between progression and time between bx, age, gender, alcohol, ART use, CD4 cell count, ALT level, or steatosis or exposure to interferon.  

Conclusions:  Unexpectedly > 25% of co-infected patients with mild fibrosis on initial liver bx had significant fibrosis on subsequent bx. If confirmed by others, these data do not support the application of current HCV treatment guidelines to HIV-infected patients on the basis of a single liver biopsy, and suggest that such patients should be closely monitored for liver disease progression. Additional research is urgently needed to identify better predictors of liver disease stage and progression in co-infected patients.  

Keywords: HCV; Antiretroviral therapy; liver biopsy