Background:  Hepatitis C virus (HCV) -related cirrhosis is a major cause of mortality in HIV⁺ patients. However, little is known about the hepatic venous pressure gradient in this population and its possible influence on the natural history of liver disease. Our objective was to compare hepatic hemodynamic study findings and portal hypertension-related clinical features in HCV-infected cirrhotic patients with and without HIV infection.
Methods:  We retrospectively analyzed all HCV-infected cirrhotic patients (HIV⁺ and HIV^–) who underwent a hepatic hemodynamic study between 2002 and 2005 at our institution. Epidemiological, clinical, biological, and hemodynamic data were recorded.
Results:  A total of 269 HCV-infected cirrhotic patients underwent hepatic hemodynamic study:  221 HIV^– and 48 HIV⁺ (mean [SD] CD4⁺ cells 357 [233]/mm³; 32 [67%] with HIV RNA <50 copies/mL). The mean (SD) follow-up after hepatic hemodynamic study was 21 (17) months. In comparison with HIV^– patients, HIV⁺ patients were younger (mean [SD] 41 [6] years vs 54 [10] years, p = 0.001] and had a lower frequency of hepatocellular carcinoma (2 [4%] vs 55 [25%], p = 0.001). No significant differences were found between HIV^– and HIV⁺ patients in sex, Child-Pugh-Turcotte score, Mayo end-stage liver disease (MELD) score, liver decompensation as a whole, ascites, and encephalopathy. The hepatic venous pressure gradient was significantly lower in HIV⁺ than in HIV^– patients (mean [SD] 16 [5] mmHg vs 18 [5] mmHg, p = 0.04]. Gastro-esophageal varices were less frequent in HIV⁺ than in HIV^– patients (37% vs 77%, p = 0.0001), despite a lower frequency of beta-blocker therapy in HIV⁺ than in HIV^– patients (7% vs 32%, p = 0.0001). During follow-up of patients with compensated cirrhosis (n = 96), a similar frequency of decompensation was observed in HIV⁺ and HIV^– patients (6 of 18 or 31% vs 27 of 76 or 35%). Ascites was the main cause of decompensation in 100% of HIV⁺ patients and in 23 (85%) HIV^– patients, followed, in this last group, by variceal bleeding (n = 2) and encephalopathy (n = 2).
Conclusions:  Our data suggest that the degree of portal hypertension in HCV-cirrhotic patients is lower in HIV⁺ than in HIV^– patients despite a similar severity of liver disease.