Do type and duration of antiretroviral therapy attenuate liver fibrosis in HIV-hepatitis C virus-coinfected patients?

Abstract

Background. This study aimed to determine whether type and duration of therapy for human immunodeficiency virus (HIV) infection attenuates liver fibrosis in patients with HIV and hepatitis C virus (HCV) coinfection. Methods. Patients with HCV monoinfection (group 1) and HIV-HCV coinfection were retrospectively selected; the latter patients were classified into the following 3 groups: group 2, patients who received no therapy or only nucleoside reverse-transcriptase inhibitors (NRTIs); group 3, those who received highly active antiretroviral therapy (HAART); and group 4, those who initially received NRTIs followed by HAART. Fibrosis stage (scale, 0-6) and necroinflammatory score (scale, 0-18) were assessed according to the Ishak system. Data are presented as mean ± standard deviation. Results. Three hundred eighty-one patients (296 HCV-monoinfected patients and 85 HIV-HCV-coinfected patients) were recruited. The durations of HIV therapy before liver biopsy was performed for groups 2, 3, and 4 were 3.8 ± 2.8, 3.3 ± 1.8, and 6.6 ± 2.2 years. The time from HIV diagnosis to HAART initiation was shorter for group 3 than for group 4 (9.1 ± 7.3 vs. 34.1 ± 13.1 months; P < .0001). Groups 1 and 3 had similar fibrosis stages (3.1 ± 2 vs. 3.4 ± 2.4), rates of fibrosis progression (0.13 ± 0.09 vs. 0.16 ± 0.11 per year), and necroinflammatory scores (6.1 ± 1.8 vs. 6.1 ± 2.0). Groups 2 and 4 had significantly more-advanced liver disease, as determined by fibrosis stage (4.6 ± 1.8 vs. 4.3 ± 2.0; P < .0009), rate of fibrosis progression (0.24 ± 0.11 vs. 0.20 ± 0.10 per year; P < .0001), and prevalence of cirrhosis (68% vs. 55%; P< .006), compared with group 1. Conclusions. HIC-HCV-coinfected subjects who receive HAART as their sole form of therapy have liver histology findings comparable to those for HCV-monoinfected patients. A similar degree of benefit is not observed for HIV-HCV-coinfected patients who receive no therapy, NRTIs, or HAART after NRTIs, despite having a longer duration of therapy. © 2005 by the Infectious Diseases Society of America. All rights reserved.