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Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults.
AIDS. 2007 Oct 18; 21(16):2209-16.AIDS

Abstract

OBJECTIVES

To define the incidence of fibrosis progression among hepatitis C virus (HCV)/HIV-co-infected adults, to assess whether HCV or HIV treatment alters the risk of progression, and to determine the utility of liver biopsy to predict future disease.

DESIGN

This prospective cohort evaluated 184 HIV/HCV-co-infected individuals who had at least two liver biopsies (median interval 2.9 years).

METHODS

Biopsies were scored according to the Ishak modified histological activity index scoring system by a single pathologist blind to biopsy sequence. Significant fibrosis progression was defined as an increase of at least two Ishak fibrosis units between the first and second liver biopsy. Logistic regression analysis was used to assess determinants of fibrosis progression.

RESULTS

A total of 174 non-cirrhotic patients were eligible; the majority were African-American men undergoing HIV treatment. On initial biopsy, no or minimal fibrosis was identified in 136 patients (77%). Significant fibrosis progression occurred in 41 patients (24%). Measures of HIV disease and its treatment before and after initial biopsy were not significantly different in progressors and non-progressors. Fibrosis progression was not associated with HCV treatment, which was received by 37 patients (21%) but only three sustained HCV-RNA suppression. In adjusted analysis, only an elevated serum aspartate aminotransferase level between biopsies was associated with progression (odd ratio 3.4, 95% confidence interval 1.4-7.9).

CONCLUSION

Over a 3-year interval, significant fibrosis progression can occur in co-infected individuals even if minimal disease was detected on initial biopsy. In this context, factors other than treatment for HIV or HCV modify the risk of fibrosis progression.

Authors+Show Affiliations

Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. msulkowski@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18090048

Citation

Sulkowski, Mark S., et al. "Rapid Fibrosis Progression Among HIV/hepatitis C Virus-co-infected Adults." AIDS (London, England), vol. 21, no. 16, 2007, pp. 2209-16.
Sulkowski MS, Mehta SH, Torbenson MS, et al. Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS. 2007;21(16):2209-16.
Sulkowski, M. S., Mehta, S. H., Torbenson, M. S., Higgins, Y., Brinkley, S. C., de Oca, R. M., Moore, R. D., Afdhal, N. H., & Thomas, D. L. (2007). Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS (London, England), 21(16), 2209-16.
Sulkowski MS, et al. Rapid Fibrosis Progression Among HIV/hepatitis C Virus-co-infected Adults. AIDS. 2007 Oct 18;21(16):2209-16. PubMed PMID: 18090048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AU - Sulkowski,Mark S, AU - Mehta,Shruti H, AU - Torbenson,Michael S, AU - Higgins,Yvonne, AU - Brinkley,Sherilyn C, AU - de Oca,Ruben Montes, AU - Moore,Richard D, AU - Afdhal,Nezam H, AU - Thomas,David L, PY - 2007/12/20/pubmed PY - 2008/3/11/medline PY - 2007/12/20/entrez SP - 2209 EP - 16 JF - AIDS (London, England) JO - AIDS VL - 21 IS - 16 N2 - OBJECTIVES: To define the incidence of fibrosis progression among hepatitis C virus (HCV)/HIV-co-infected adults, to assess whether HCV or HIV treatment alters the risk of progression, and to determine the utility of liver biopsy to predict future disease. DESIGN: This prospective cohort evaluated 184 HIV/HCV-co-infected individuals who had at least two liver biopsies (median interval 2.9 years). METHODS: Biopsies were scored according to the Ishak modified histological activity index scoring system by a single pathologist blind to biopsy sequence. Significant fibrosis progression was defined as an increase of at least two Ishak fibrosis units between the first and second liver biopsy. Logistic regression analysis was used to assess determinants of fibrosis progression. RESULTS: A total of 174 non-cirrhotic patients were eligible; the majority were African-American men undergoing HIV treatment. On initial biopsy, no or minimal fibrosis was identified in 136 patients (77%). Significant fibrosis progression occurred in 41 patients (24%). Measures of HIV disease and its treatment before and after initial biopsy were not significantly different in progressors and non-progressors. Fibrosis progression was not associated with HCV treatment, which was received by 37 patients (21%) but only three sustained HCV-RNA suppression. In adjusted analysis, only an elevated serum aspartate aminotransferase level between biopsies was associated with progression (odd ratio 3.4, 95% confidence interval 1.4-7.9). CONCLUSION: Over a 3-year interval, significant fibrosis progression can occur in co-infected individuals even if minimal disease was detected on initial biopsy. In this context, factors other than treatment for HIV or HCV modify the risk of fibrosis progression. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/18090048/Rapid_fibrosis_progression_among_HIV/hepatitis_C_virus_co_infected_adults_ L2 - https://doi.org/10.1097/QAD.0b013e3282f10de9 DB - PRIME DP - Unbound Medicine ER -