Epidemiology

Severe liver fibrosis increases with age in patients with both HIV and HCV

Last Updated: 2004-01-12 16:49:58 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Coinfection with HIV increases the risk of severe liver fibrosis in patients infected with hepatitis C virus (HCV) who also have elevated serum alanine aminotransferase levels, results of a European study suggest. Increasing age, alcohol consumption, and reduced CD4 cell counts are independently linked to severity of fibrosis, but antiretroviral therapy is not.

Since the introduction of highly active antiretroviral therapy (HAART), liver disease has turned into one of the most important causes of morbidity in those infected with HIV, Dr. Vincent Soriano and colleagues note. However, factors linked to severity of liver fibrosis in the co-infected, HAART treated population are unknown.

Dr. Soriano, at Hospital Carlos III in Barcelona, and his team in Spain, Italy, France and Germany evaluated data from 914 patients, 35% of whom had severe fibrosis on biopsy (bridging fibrosis with many septa or cirrhosis). They discuss their findings in the January 1st issue of Clinical Infectious Diseases.

Multivariate analysis revealed three variables independently associated with severe liver fibrosis: age > 35 years, consumption of > 50 g alcohol/day, and CD4 count < 500 cells/�L.

Although duration of HCV infection and use of HAART were linked to fibrosis severity in univariate analyses, the authors suggest that both were confounding factors for age.

Thus, they conclude, anti-HCV therapy with pegylated interferon and ribavirin "must be considered a priority for coinfected patients, and, in the absence of contraindications, it should be provided at the earliest possible time," they write. Measures to prevent HCV exposure -- such as needle-exchange programs for injecting drug users -- and reducing alcohol consumption are urgently needed.

Clin Infect Dis 2004;38:128-133.