1060 
Use of Serum Markers to Assess Progression of Liver Disease in HIV HCV-co-infected Women
K Bambha1, A French2, C Pierce3, E Seaberg3, H Strickler4, A Howard4, G Sharp5, P Tien1, Marion Peters*1, and WIHS
1Univ of California, San Francisco, US; 2Stroger Hosp of Cook County, Chicago, IL, US; 3Johns Hopkins Univ, Baltimore, MD, US; 4Albert Einstein Coll of Med, Bronx, NY, US; and 5NIAID, NIH, Bethesda, MD, US
Background: Co-infection with hepatitis C virus (HCV)
is a major cause of morbidity and mortality in HIV-infected individuals. Women
with HCV have been shown to have milder and less progressive liver disease than
men. We evaluated whether indirect serum markers, measured in blood samples at
baseline and 5 and 10 years’ follow-up were predictive of fibrosis progression
or death among HIV-infected women with and without HCV co-infection.
Methods: Serum markers of fibrosis were evaluated in
the Women’s Interagency HIV Study (WIHS) over time from the first year of the
study and the latest year of enrollment by aspartate aminotransferase/platelet
ratio index (APRI) and FIB-4. Associations with clinical outcome of all cause
mortality were evaluated using time-dependent Cox regression analysis.
Results: Similar results were noted for FIB-4 and
APRI. Results of FIB-4 with are shown in the table. Compared with HIV-mono-infected
women, HIV/HCV-co-infected women were more likely to have severe fibrosis or cirrhosis
at each interval, and this difference increased in magnitude over time. However
by these indirect methods, nearly half of co-infected women had not progressed
over 5 years and 41% had not progressed over 10 years. In addition, of the 276
co-infected women who died with co-infection, 38% had severe fibrosis/cirrhosis
estimated by FIB-4. In multivariable modeling, baseline APRI was predictive of
all-cause mortality, with moderate or severe elevations at baseline conferring
hazard ratios (HR, 95%CI) of 1.5 (1.2 to 1.8) and 2.7 (2.0 to 3.7),
respectively, after controlling for HIV (HR 4.0, CI 2.7 to 5.7); HCV (HR 1.8, CI
1.4 to 2.1); HBV (HR 1.7, CI 1.1 to 2.7); HAART (HR 0.8, CI 0.7 to 1.0); heavy
alcohol use (HR 1.0, CI 0.8 to 1.4); age per 10-year increase (HR 1.4, CI 1.3
to 1.6); and obesity (HR 0.8, CI 0.6 to 0.9).
Conclusions: Women co-infected with HCV had more
progressive liver disease than those with HIV alone. By these indirect methods,
nearly half of the co-infected women had not progressed over 5 years and 41%
had not progressed over 10 years. While APRI and FIB-4 are indirect markers of
liver fibrosis, they were independently associated with all-cause mortality in
the WIHS and may have clinical prognostic utility among women with HIV and HCV
infections.
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