Undetectable HIV viral load in HIV-HCV coinfected patients slows liver fibrosis progression rate

In the pre-HAART era, HIV-HCV-coinfected patients were reported to have a faster fibrosis progression rate (FPR) than HCV-monoinfected patients. One preliminary study suggested that HAART might slow down FPR. The study was conducted in New York City and at four sites in Puerto Rico.

In the current study, overall, 685 consecutive HCV-infected patients, 297 HIV-positive and 388 HIV-negative, who underwent a liver biopsy (Ishak scoring) were analysed. A known date of HCV infection was available in 675.

In HIV-HCV-coinfected patients, log10 HIV RNA level was strongly correlated with FPR, but CD4+ cell count only weakly.

HIV-HCV-coinfected patients with any HIV viral load >400 copies/ml had a faster FPR than coinfected patients with undetectable plasma HIV RNA and than HCV-monoinfected patients who in turn had a similar FPR as HIV-HCV-coinfected patients with <400 copies/ml (p=0.253).

HIV viral load is strongly correlated with FPR in HIV-HCV-coinfected patients, but CD4+ cell count only weakly. Undetectable HIV viral load is associated with slower FPR than with any HIV level and the same as in HCV-monoinfection.

Comment

This study confirms previous data published by Benhamou et al Hepatology 1999 and Quirishi et al. in The Lancet 2003 showing that patients on effective antiretroviral treatment have a slower fibrosis progression and a lower incidence of liver failure. A methodological problem is that in principle only studies with paired biopsies and not cross sectional studies can answer the questions of fibrosis progression accurately.

N Bräu and others. Control of HIV viral load through Highly Active Antiretroviral Therapy (HAART) slows down liver fibrosis progression in HIV/HCV-coinfection and makes it the same as in HCV-monoinfection. The Puerto Rico-New York Hepatitis C Study Group. Abstract 91. 39th EASL, 14-18 April 2004, Berlin Germany.

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