Liver-related death in human
immunodeficiency virus (HIV)-infected individuals is about 10 times higher
compared with the general population, and the prevalence of significant liver
fibrosis in those with HIV approaches 15%.
The present study aimed to assess
risk factors for development of hepatic fibrosis in HIV patients receiving a
modern combination anti-retroviral therapy (cART).This cross-sectional
prospective study included 432 HIV patients, of which 68 (16%) patients were
anti-hepatitis C virus (HCV) positive and 23 (5%) were HBsAg positive.Health
trajectory including clinical characteristics and liver fibrosis stage assessed
by transient elastography were collected at inclusion. Liver stiffness values
>7.1 kPa were considered as significant fibrosis, while values >12.5 kPa
were defined as severe fibrosis. Logistic regression and Cox regression uni-
and multivariate analyses were performed to identify independent factors
associated with liver fibrosis.
Significant liver fibrosis was detected in 10%
of HIV mono-infected, in 37% of HCV co-infected patients, and in 18% of
hepatitis B virus co-infected patients. The presence of diabetes mellitus (odds
ratio [OR] = 4.6) and FIB4 score (OR = 2.4) were independently associated with
presence of significant fibrosis in the whole cohort. Similarly, diabetes
mellitus (OR = 5.4), adiposity (OR = 4.6), and the FIB4 score (OR = 3.3) were independently
associated with significant fibrosis in HIV mono-infected patients.
Importantly, cumulative cART duration protected, whereas persistent HIV viral
replication promoted the development of significant liver fibrosis along the
duration of HIV infection.
Our findings strongly indicate that besides known
risk factors like metabolic disorders, HIV may also have a direct effect on
fibrogenesis. Successful cART leading to complete suppression of HIV
replication might protect from development of liver fibrosis.
Below: FIGURE 1. (A) Distribution of fibrosis among subgroups.
(B–D) Association between LS and HIV duration, time naive, and DM. (E–H)
Association between LS and BMI, DM, HIV duration, and time naive in HIV
mono-infected patients compared with coinfected patients. Data are presented as
mean ± SEM. BMI = body mass index, DM = diabetes mellitus, HIV = human
immunodeficiency virus, LS = liver stiffness, SEM = standard error of the mean.
Full article at: http://goo.gl/1el3nx
- 1From the Department of Medicine I, University Hospital Bonn, Bonn, Germany (RM, RS, CS-Z, CB, J-CW, JT, JKR); German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany (RM, CS-Z, CB, J-CW, JKR); and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark (JT).
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