977
Prevalence, Etiology, and Clinical Presentation of HIV+ Patients with Liver Cirrhosis
C Castellares*, L Martin-Carbonero, P Barreiro, P Labarga, B Ramos, A Ruiz-Sancho, S Novoa-Rodriguez, G Ramirez-Olivencio, J Gonzalez-Lahoz, and V Soriano
Hosp Carlos III, Madrid, Spain
Background: The reduction of AIDS events due to HAART use,
together with frequent chronic viral hepatitis B (HBV) and C (HCV) in patients
with HIV infection, have rendered liver cirrhosis one
of the leading causes of morbidity and mortality in this population. Transient elastometry (FibroScan) is a
validated non-invasive procedure to assess liver fibrosis, which allows examination
of large number of patients.
Methods:
A cross-sectional study, including
demographics and clinical and laboratory characteristics of all consecutive HIV+
patients on regular follow-up at our institution was performed. Patients with
liver cirrhosis were compared with those without cirrhosis, according to FibroScan estimates greater or below 12.5 kPa.
Results: A total of 2168 HIV+ patients were
examined, of whom 181 (8%) were found to be cirrhotic.
Conclusions: Liver cirrhosis is quite prevalent (8%) in HIV+ patients,
particularly in those with chronic HCV (19%), HCV/HBV (50%), or HCV/HBV/HDV
(100%) co-infection, and alcohol abusers (16%). Chronic HBV alone is not
associated with a higher risk of cirrhosis (only 7% of them), probably due to
the wide use of anti-HBV ART (mainly tenofovir ± lamivudine or emtricitabine). A few
patients had cirrhosis of unclear origin, in which HIV infection itself or ART
might play a major role.
|
|
Cirrhotic
|
Non-cirrhotic
cirrhotics
|
p
|
|
No. (%)
|
181 (8.3)
|
1,987 (91.7)
|
|
|
Male (%)
|
143 (79)
|
1,510 (76)
|
0.36
|
|
Mean age (years)
|
43±5
|
42±8
|
0.67
|
|
Risk group (%)
IDU
MSM
Heterosexual
Transfusion
Other/Unknown
|
148 (82)
18 (10)
11 (6)
2 (1)
2 (1)
|
854 (43)
715 (36)
318 (16)
20 (1)
80 (4)
|
<0.01
<0.01
<0.01
0.8
0.05
|
|
HIV status
HIV RNA <50
copies/mL (%)
Mean HIV RNA (log copies/mL)
CD4 count <200
cell/mL (%)
Mean CD4 count (cells/mL)
|
121 (67)
2.31±1,06
33 (18)
408±269
|
1,232 (62)
2.36±1,07
238 (12)
528±308
|
0.23
0.57
0.01
<0.05
|
|
Liver status
Mean AST (IU/L)
Mean ALT (IU/L)
Total bilirubin (mg/dL)
Albumin (g/dL)
Prothrombin rate (%)
Platelets per nL
Chronic hepatitis (%)
HIV+ alone
HBV
HCV
HBV/HCV
HBV/HCV/HDV
Alcohol abuse
|
91±62
81±62
1.8±1.2
3.4±2.1
81±4
124±70
12 (6.6)
6 (3.3)
149 (82.3)
9 (5.0)
5 (2.8)
95 (52.5)
|
43±36
44±38
0.9±0.5
4.8±1.8
92±5
212±77
1,272 (64)
78 (3.9)
628 (31.6)
9 (0.5)
0 (0)
479 (24.1)
|
<0.01
<0.01
<0.05
<0.05
<0.05
<0.01
<0.01
0.83
<0.01
<0.01
<0.01
<0.01
|
|
