Reuters Health Information (2010-09-30): HIV coinfection does not alter course of HCV liver fibrosis
HIV coinfection does not alter course of HCV liver fibrosis
Last Updated: 2010-09-30 16:55:05 -0400 (Reuters Health)
NEW YORK (Reuters Health) - HIV does not affect the progression of liver fibrosis in patients with hepatitis C virus (HCV) infection, according to an August 20th article in Clinical Gastroenterology and Hepatology.
In coinfected patients, therefore, "decisions on whether or not to begin HCV therapy should depend on patient compliance and likelihood of sustained virologic response and not on concerns about rapid disease progression," the research team advises.
"Because sustained virologic response rates with current therapy are suboptimal, it is reasonable to defer HCV therapy in those with mild disease until better therapies for HCV are available," the authors add.
Earlier reports had suggested that the course of HCV is worse in individuals with HIV coinfection, whereas more recent studies suggested their fibrosis progression was similar to that seen with HCV alone.
To address this controversy, Dr. Richard K. Sterling and colleagues from Virginia Commonwealth University Health System in Richmond studied 59 patients with both viruses who didn't have either cirrhosis or a sustained response to treatment. They compared paired biopsies from these patients (obtained at an average interval of 4.7 years) to paired biopsies from 59 HCV patients without HIV, matched by age and baseline severity of fibrosis. The mean between-biopsy interval in the control group was slightly longer, at 5.9 years.
The fibrosis progression rate between the first and second biopsy was 0.12 units/year in patients with HIV/HCV, not significantly different from the 0.091 units/year in patients with HCV only (p=0.72).
In 38 pairs matched on all baseline factors, the results were similar. Fibrosis progression was 0.15 units/year in coinfected patients and 0.18 units/year in monoinfected patients (p=0.7).
Other than a lower body mass index, there were no other factors associated with fibrosis progression.
Twenty percent of HIV/HCV patients progressed over time (10% by one stage and 10% by two or more stages), but this was not significantly different from what happened in the control group (17% one stage and 5% two stages), the investigators say.
They note, however, that their coinfected patients had mild liver disease at baseline and well controlled HIV.
"Because there were no clinical or laboratory parameters that predicted disease progression," they add, "we therefore recommend that all coinfected patients should be considered for repeat assessment of disease severity by liver biopsy at periodic intervals in order to identify those who progress."
Clin Gastroenterol Hepatol 2010.