Clinical

Liver biopsy informative in HIV and HCV coinfection

Last Updated: 2006-08-31 9:02:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with HIV and chronic hepatitis C virus (HCV) infection may have normal alanine aminotransferase (ALT) levels, but nonetheless they should probably have a liver biopsy, Spanish researchers report in the September 1st issue of Clinical Infectious Diseases.

Dr. Juan Berenguer of Hospital General Gregorio Maranon, Madrid and colleagues found that there may be significant fibrosis in such cases.

The researchers studied 256 patients with HIV and HCV coinfection. Of this group, 24 (9.4%) had an ALT level within the normal range on at least two occasions within a 6-month period.

Clinical data and histological findings showed advanced fibrosis (stage F3 and F4) in 78 (33.7%) of the patients with elevated ALT levels.

This was not true of any of the patients with normal ALT. However, 23 of the 24 in this group (96%) had some degree of fibrosis, and 7 (29%) had F2 stage fibrosis.

There were no differences in a variety of factors including, age, CD4+ cell count and duration of HCV infection among subjects with and without normal ALT levels. On the other hand, a significantly higher proportion of patients with high ALT levels had the HCV 3 genotype than was the case in those with normal ALT levels (26.9% versus 4.2%).

In light of these findings, the researchers suggest liver biopsy in patients with HIV and HCV coinfection who have normal ALT levels, "to determine the extent of liver fibrosis and, consequently, to assess suitability of treatment."

Clin Infect Dis 2006;43:640-644.