1055
Increased Rates of Fibrosis Progression between Sequential Liver Biopsies in HIV/HCV-co-infected Patients
Juan Macias*1, J Berenguer2, A Arizcorreta3, A Rivero4, A Gutierrez5, M Gonzalez-Serrano6, E Ortega7, P Miralles2, J Mira1, and J Pineda1
1Hosp Univ de Valme, Seville, Spain; 2Hosp Univ Gregorio Maranon, Madrid, Spain; 3Hosp Univ Puerta del Mar, Cadiz, Spain; 4Hosp Univ Reina Sofia, Cordoba, Spain; 5Hosp Univ Virgen del Rocio, Seville, Spain; 6Hosp Univ Virgen de la Victoria, Malaga, Spain; and 7Hosp Gen Univ de Valencia, Spain
Background: A few studies have assessed the observed
fibrosis progression between serial liver biopsies in HIV/hepatitis C virus (HCV)
-co-infected patients. The observed fibrosis progression was faster than in
single-biopsy studies. Approximately half of the patients progressed at least 1
stage and a quarter of them were very fast progressors, i.e. liver fibrosis
increased 2 or more stages in these patients. The risk factors for progression
were not clear. These findings need confirmation due to their deep clinical
implications. Because of this, we evaluated the observed fibrosis progression
rates of HIV/HCV-co-infected patients and the risk factors for accelerated
progression.
Methods: Patients with HIV/HCV co-infection who
underwent 2 serial liver biopsies, separated at least by 1 year, were included
in this retrospective cohort if they did not show other possible causes of
liver disease. Patients with cirrhosis (F4) in the first liver biopsy were
excluded. Fibrosis was staged according to the Scheuer score (F0-F4).
Results: We included 83 patients with complete data
in this analysis. The median (Q1-Q4) time between both liver biopsies was 40
(31 to 65) months. During the follow-up, 67 (81%) patients received HAART, 51
(76%) of whom showed undetectable HIV RNA. Of 36 patients who received anti-HCV
treatment after the first liver biopsy, 18 (50%) showed end-of-treatment
response or erradication. The table summarizes the changes in fibrosis stage.
Patients showed the following changes in stage: regression ≥1 stage, 13
(16%); no change, 36 (43%); progression ≥1 stage, 34 (41%). In the
ultivariate analysis, factors associated with progression ≥1 stage were
moderate-to-severe lobular inflammation (L0-1 vs L2-4), adjusted OR (AOR) (95%
confidence interval, 95%CI) 3 to 3 (1.3 to 8.7), p = 0.02, and end-of-treatment
response/sustained virological response AOR (95%CI) 0.3 (0.7 to 0.9), p =
0.04.
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First liver biopsy
|
Follow-up liver biopsy
|
|
|
Total
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F0
|
F1
|
F2
|
F3
|
F4
|
|
F0, n (%)
|
26 (31)
|
10 (39)
|
7 (27)
|
5 (19)
|
3 (12)
|
1 (4)
|
|
F1, n (%)
|
38 (46)
|
8 (21)
|
16 (42)
|
13 (34)
|
1 (3)
|
0 (0)
|
|
F2, n (%)
|
4 (5)
|
1 (25)
|
0 (0)
|
1 (25)
|
0 (0)
|
2 (50)
|
|
F3, n (%)
|
14 (18)
|
1 (7)
|
2 (14)
|
1 (7)
|
9 (60)
|
2 (14)
|
Conclusions: Fibrosis progression is frequently
observed in HIV/HCV-co-infected patients under HAART over a period of 3 years.
Moderate-to-severe lobular inflammation at baseline liver biopsy is associated
with an increased risk of progressing ≥1 fibrosis stage. Response to
anti-HCV treatment can prevent progression.
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