931 
Faster Progression of Liver Fibrosis in Chronic Hepatitis Due to HCV than to HVB in HIV+ Patients in the Tenofovir Era
C Castellares,*, L Martin-carbonero, P Barreiro, M Nuñez, B Ramos, J Sheldon, L Galindo, R Casado, J González-lahoz, and V Soriano
Hosp Carlos III, Madrid, Spain
Background:
Both chronic hepatitis B and C progress faster to cirrhosis in HIV+ patients.
Progression could be further accelerated in dually HBV-HCV patients. It is
unclear whether liver fibrosis progression is different in HBV vs HCV, and what
is the impact of antiretroviral therapy, either enhancing immune status and/or
suppressing HBV replication when antiretrovirals active against HBV are used.
The aim of this study was to compare the hepatic fibrosis staging in a large
group of HIV+ patients with chronic hepatitis B and/or C.
Patients
& Methods: All HBsAg+ patients with HIV infection who
underwent liver fibrosis assessment using elastometry (FibroScan) at our center
were compared with a group of HCV/HIV-coinfected patients.
Results: A
total of 231 subjects were examined. Overall, 92% of 72 HBsAg+ patients were
under antiretrovirals active against HBV (35% TDF+FTC; 33% TDF+3TC; 14% 3TC;
10% TDF) and 82% had undetectable serum HBV-DNA.
|
|
HBV (44)
|
HCV (159)
|
HBV/HCV (28)
|
P
|
|
Gender (male)
|
43 (98%)
|
108 (68%)
|
21 (75%)
|
<0.01
|
|
IDU
|
6 (14%)
|
119 (86%)
|
25 (89%)
|
<0.01
|
|
Age (years; median; IQR)
|
43 (38-48)
|
43 (40-46)
|
43 (39-45)
|
0.7
|
|
Alcohol >60 gr/day
|
10 (24%)
|
59 (50%)
|
8 (35%)
|
0.01
|
|
Median CD4 count
(cells/ul)
|
497 (325-680)
|
493 (322-660)
|
489 (345-638)
|
0.8
|
|
Plasma HIV-RNA <50 cop/ml
|
33 (75%)
|
94 (67%)
|
26 (93%)
|
0.006
|
|
HAART
PI
|
41 (93%)
19 (43%)
|
135 (85%)
87 (55%)
|
26 (93%)
15 (54%)
|
0.4
0.3
|
|
Liver fibrosis (KPa)
Mild (<9.5) (F0-F2)
Moderate (9.5-13.9) (F3)
Severe (≥14) (F4)
|
36 (82%)
5 (11%)
3 (7%)
|
103 (65%)
25 (16%)
31 (19%)
|
13 (46%)
5 (18%)
10 (36%)
|
0.01
|
Patients with chronic hepatitis C and dual HBV/HCV had severe
liver fibrosis more frequently than subjects with chronic hepatitis B alone. In
the multivariate logistic regression analysis, significant hepatic fibrosis (≥9.5 KPa) was associated with HCV vs HBV (OR 3.4;
95%CI: 1.2-9.9) and with lower CD4 counts (OR per every increment of 100
cells/ul: 0.8; 95%CI: 0.7-0.9). Elevated alcohol consumption (>60 gr/day)
tended also to be associated with significant fibrosis (OR 2.1; 95%CI:
0.96-4.45; p=0.06). The risk for developing significant liver fibrosis was
further increased in patients with dual HBV/HCV vs HBV alone (OR 9.4; 95%CI:
2.7-32.6).
Conclusions:
Progression to liver cirrhosis occurs less frequently in chronic hepatitis B
than C (and particularly dual B/C hepatitis) in HIV+ patients receiving
antiretrovirals with anti-HBV activity. Prolonged suppression of HBV
replication might be the principal responsible for this benefit
|
