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Session 165 Poster Abstracts
HCV Co-Infection: Natural History
Wednesday, 1:30 - 3:30 pm
Hall B


951    
Effect of Protease Inhibitors and Non-nucleoside Reverse Transcriptase Inhibitors on Liver Histology in HIV/ HCV Co-infection: Analysis of Patients Enrolled in the AIDS PEGASYS Ribavirin International Co-infection Trial (APRICOT)
Richard Sterling*1, E Lissen2, N Clumeck3, R Sola4, M Correa5, J Montaner6, M Sulkowski7, F Torriani8, D Dieterich9, D Messinger10, and M Nelson11
1Virginia Commonwealth Univ Hlth System, Richmond, USA; 2Virgen del Rocío Univ Hosp, Seville, Spain; 3Ctr Hosp Univ St-Pierre, Brussels, Belgium; 4Hosp del Mar, Univ Autónoma de Barcelona, Spain; 5HCFMUSP, Casa da AIDS, Sao Paulo, Brazil; 6Univ of British Columbia, Vancouver, Canada; 7Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 8Univ of California, San Diego, Treatment Ctr, USA; 9Mt Sinai Sch of Med, New York, NY, USA; 10IST GmbH, Mannheim, Germany; and 11Chelsea and Westminster Hosp, London, UK

Background:  The effect of HAART on hepatitis C virus (HCV) disease severity remains controversial. Although early studies suggested that protease inhibitors (PI) are associated with slower fibrosis progression, more recent data show no significant difference in liver histology between patients on PI and those on non-nucleoside reverse transcriptase inhibitors (NNRTI) as part of their HAART regimen. These studies, however, were small. We aimed to determine the effect of PI or NNRTI on liver histology in the large cohort of patients in APRICOT.

Methods:  Retrospective analysis of liver histology in patients entering APRICOT. The design and results of APRICOT were recently published. In 178 of 868 randomized patients no pre-biopsy HAART data were available (liver biopsies obtained until 15 months prior to the study were eligible). Patients were stratified by use of PI, NNRTI, or both within 2 months prior to biopsy. Liver histology was assessed by Ishak score and significant histology was defined as advanced fibrosis (Ishak 4 to 6). Data are expressed as mean (± SD).

Results:  Of 690 patients with evaluable data, 312 (45%) were taking PI, 205 (30%) were taking NNRTI, 53 (8%) were taking both, and 120 (17%) were on neither (see the table). Of those not on a PI or NNRTI, 43 (36%) were not on any HAART within 2 months prior to liver biopsy. These groups had similar demographic characteristics (age, race, weight, body mass index, and HCV RNA titer), and mode of infection. Overall, advanced fibrosis (Ishak score 4 to 6) was more frequent in patients receiving PI/NNRTI than in patients not receiving PI/NNRTI (24% vs 15%, p = 0.026) independent of the type (NNRTI or PI).

Conclusions:  Advanced fibrosis is common in those with HIV/HCV co-infection. While there were no significant differences in liver histology between patients receiving a PI- compared with a NNRTI-containing regimen, these data suggest that the choice of HAART should be based on potency and durability of the ART regimen and not as much on the potential for hepatotoxicity and progression to fibrosis.

 

Keywords: HAART; liver histology; hepatic fibrosis