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HIV-HCV co-infected patients with low CD4+ cell nadirs are at risk for faster fibrosis progression and portal hypertension.
J Viral Hepat. 2010 Jun; 17(6):400-9.JV

Abstract

Patients co-infected with the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) are fraught with a rapid fibrosis progression rate and with complications of portal hypertension (PHT) We aimed to assess the influence of immune function [Centers of Disease Control and Prevention (CDC) stage] on development of PHT and disease progression in HIV-HCV co-infection. Data of 74 interferon-naïve HIV-HCV co-infected patients undergoing liver biopsy, measurement of portal pressure and of liver stiffness and routine laboratory tests (including CD4+ cell count, HIV and HCV viral load) were analysed. Time of initial exposure (risk behaviour) was used to assess fibrosis progression. Fibrosis progression, time to cirrhosis and portal pressure were correlated with HIV status (CDC stage). HIV-HCV patients had rapid progression of fibrosis [0.201 +/- 0.088 METAVIR fibrosis units/year (FU/y)] and accelerated time to cirrhosis (24 +/- 13 years), high HCV viral loads (4.83 x 10(6) IU/mL) and a mean HVPG at the upper limit of normal (5 mmHg). With moderate or severe immunodeficiency, fibrosis progression was even higher (CDC-2 = 0.177 FU/y; CDC-3 = 0.248 FU/y) compared with patients with higher CD4+ nadirs (CDC-1 = 0.120 FU/y; P = 0.0001). An indirect correlation between CD4+ cell count and rate of fibrosis progression (R = -0.6654; P < 0.001) could be demonstrated. Hepatic venous pressure gradient (HVPG) showed early elevation of portal pressure with median values of 4, 8 and 12 mmHg after 10, 15 and 20 years of HCV infection for CDC-3 patients. Patients treated with highly active anti-retroviral therapy (HAART) had similar rates of progression and portal pressure values than patients without HAART. Progression of HCV disease is accelerated in HIV-HCV co-infection, being more pronounced in patients with low CD4+ cell count. A history of a CD4+ cell nadir <200/microL is a risk factor for rapid development of cirrhosis and PHT. Thus, HCV treatment should be considered early in patients with HIV-HCV co-infection and largely preserved CD4+ cell counts.

Authors+Show Affiliations

Department of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria.No 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

Language

eng

PubMed ID

19780945

Citation

Reiberger, T, et al. "HIV-HCV Co-infected Patients With Low CD4+ Cell Nadirs Are at Risk for Faster Fibrosis Progression and Portal Hypertension." Journal of Viral Hepatitis, vol. 17, no. 6, 2010, pp. 400-9.
Reiberger T, Ferlitsch A, Sieghart W, et al. HIV-HCV co-infected patients with low CD4+ cell nadirs are at risk for faster fibrosis progression and portal hypertension. J Viral Hepat. 2010;17(6):400-9.
Reiberger, T., Ferlitsch, A., Sieghart, W., Kreil, A., Breitenecker, F., Rieger, A., Schmied, B., Gangl, A., & Peck-Radosavljevic, M. (2010). HIV-HCV co-infected patients with low CD4+ cell nadirs are at risk for faster fibrosis progression and portal hypertension. Journal of Viral Hepatitis, 17(6), 400-9. https://doi.org/10.1111/j.1365-2893.2009.01197.x
Reiberger T, et al. HIV-HCV Co-infected Patients With Low CD4+ Cell Nadirs Are at Risk for Faster Fibrosis Progression and Portal Hypertension. J Viral Hepat. 2010;17(6):400-9. PubMed PMID: 19780945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV-HCV co-infected patients with low CD4+ cell nadirs are at risk for faster fibrosis progression and portal hypertension. AU - Reiberger,T, AU - Ferlitsch,A, AU - Sieghart,W, AU - Kreil,A, AU - Breitenecker,F, AU - Rieger,A, AU - Schmied,B, AU - Gangl,A, AU - Peck-Radosavljevic,M, Y1 - 2009/09/15/ PY - 2009/9/29/entrez PY - 2009/9/29/pubmed PY - 2010/9/24/medline SP - 400 EP - 9 JF - Journal of viral hepatitis JO - J Viral Hepat VL - 17 IS - 6 N2 - Patients co-infected with the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) are fraught with a rapid fibrosis progression rate and with complications of portal hypertension (PHT) We aimed to assess the influence of immune function [Centers of Disease Control and Prevention (CDC) stage] on development of PHT and disease progression in HIV-HCV co-infection. Data of 74 interferon-naïve HIV-HCV co-infected patients undergoing liver biopsy, measurement of portal pressure and of liver stiffness and routine laboratory tests (including CD4+ cell count, HIV and HCV viral load) were analysed. Time of initial exposure (risk behaviour) was used to assess fibrosis progression. Fibrosis progression, time to cirrhosis and portal pressure were correlated with HIV status (CDC stage). HIV-HCV patients had rapid progression of fibrosis [0.201 +/- 0.088 METAVIR fibrosis units/year (FU/y)] and accelerated time to cirrhosis (24 +/- 13 years), high HCV viral loads (4.83 x 10(6) IU/mL) and a mean HVPG at the upper limit of normal (5 mmHg). With moderate or severe immunodeficiency, fibrosis progression was even higher (CDC-2 = 0.177 FU/y; CDC-3 = 0.248 FU/y) compared with patients with higher CD4+ nadirs (CDC-1 = 0.120 FU/y; P = 0.0001). An indirect correlation between CD4+ cell count and rate of fibrosis progression (R = -0.6654; P < 0.001) could be demonstrated. Hepatic venous pressure gradient (HVPG) showed early elevation of portal pressure with median values of 4, 8 and 12 mmHg after 10, 15 and 20 years of HCV infection for CDC-3 patients. Patients treated with highly active anti-retroviral therapy (HAART) had similar rates of progression and portal pressure values than patients without HAART. Progression of HCV disease is accelerated in HIV-HCV co-infection, being more pronounced in patients with low CD4+ cell count. A history of a CD4+ cell nadir <200/microL is a risk factor for rapid development of cirrhosis and PHT. Thus, HCV treatment should be considered early in patients with HIV-HCV co-infection and largely preserved CD4+ cell counts. SN - 1365-2893 UR - https://www.unboundmedicine.com/medline/citation/19780945/HIV_HCV_co_infected_patients_with_low_CD4+_cell_nadirs_are_at_risk_for_faster_fibrosis_progression_and_portal_hypertension_ L2 - https://doi.org/10.1111/j.1365-2893.2009.01197.x DB - PRIME DP - Unbound Medicine ER -