Background:  Liver fibrosis is accelerated in HIV/hepatitis C virus (HCV)-co-infected patients. Higher plasma HCV RNA levels and distinct HCV genotype distribution could play a role in this population as compared with HCV-mono-infected patients.

Methods:  Liver fibrosis was assessed using elastometry in all consecutive HIV/HCV-co-infected patients attended at our institution during the last 12 months. Hepatic stiffness was measured in KiloPascal (KPa) units and interpreted according to the Metavir score:  F0-F1 for ≤7 KPa and F2-F4 for >7 KPa.

Results:  We analyzed 283 patients of whom 71% were male, mean age 42 years old, 94% injecting drug users (IDU), 94% on HAART, mean CD4 554 cells/mL, and 72% with HIV RNA <50 copies/mL. Mean ALT was 68 IU/L and mean plasma HCV RNA was 5.9 log IU/mL. HCV genotypes distribution was:  1 (60%), 2 (2%), 3 (26%), and 4 (12%). Overall, 164 (58%) patients scored F2-F4 at elastometry. In the univariate and multivariate analyses, respectively, significant OR (95%CI) for F2-F4 stages was found for HCV genotype 3 vs others (1.93, 1.09 to 3.42 and 4.3, 1.4 to 13.3), older age (1.1, 1.03 to 1.17 and 1.12, 1.01 to 1.25), and high ALT levels (1.02, 1.01 to 1.03 and 1.03, 1.01 to 1.04). The positive predictive value for F2-F4 if ALT >55 IU/L was 87% (75 to 99%) for genotypes 3 and 68% (59 to 78%) for other genotypes. Patients with HCV genotype 1 vs 3 had higher HCV RNA levels (6.1 vs 5.7 log IU/mL; p = 0.01); however, F2-F4 was still more frequent for genotypes 3 vs 1 (71% vs 58%; p <0.05)

Conclusions:  HCV genotype 3, older age and elevated ALT levels are independent predictors of advanced liver fibrosis in HCV/HIV-co-infected patients.