Background:  HIV/HCV-co-infected patients have a faster liver fibrosis progression rate than HCV-mono-infected patients. Information regarding the effect of HAART on liver fibrosis in HIV/HCV-co-infected patients is controversial. We analyzed the effect of HAART on liver fibrosis progression in patients with HIV/HCV co-infection.

Methods:  From January 2000 to February 2005, we performed a liver biopsy on 296 HIV/HCV-co-infected patients who were naďve for anti-HCV treatment. For this study, we analyzed the data of the 213 patients who acquired HIV by intravenous drug use in which the date of HCV infection could be ascertained. Liver fibrosis was scored following the METAVIR system (F0 to F4). We carried out a multinomial logistic regression analysis to assess the association of time on HAART with the fibrosis progression index (FPI), defined as the ratio of fibrosis stage/years of HCV infection (FPI >0.1 as reference); and the association of time on HAART and stage of fibrosis (F3/F4 as reference). Both analyses were adjusted according to clinical, immunological, and virological (HIV and HCV) characteristics.

Results:  At the time of liver biopsy, the median age was 39 years, 32.4% patients were CDC clinical category C, 100% of whom had been on HAART for a median of 4.3 years, the median CD4 count was 460 cells/mm³, and 72.8% had an HIV viral load <50 copies/mL. The estimated median time since HCV infection was 21.3 years and 57.4% were infected by HCV genotype 1. The distribution of liver fibrosis in our cohort was F0 0.5%, F1 37.1%, F2 31.9%, F3 (bridging fibrosis) 18.8%, and F4 (cirrhosis) 11.7%. We found that, for each additional month on HAART, the adjusted OR of having an FPI = or <0.1 was 1.24 (CI95% 1.05 to 1.47). We also found that, for each additional month on HAART, the adjusted OR of having an F0-F1 vs F3/F4 stage was 1.24 (CI95% 1.01 to 1.48) and the adjusted OR of having F2 vs F3/F4 was 1.22 (CI95% 1.01 to 1.48).

Conclusions:  Our results show that HAART reduces the fibrosis progression rate and the development of bridging fibrosis and cirrhosis in HIV/HCV-co-infected patients