Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis
BACKGROUND:
Liver
disease is a major cause of mortality among HIV-infected persons. There is
limited information about the extent to which HIV disease severity impacts
liver disease progression.
METHODS:
We
determined the incidence and predictors of advanced hepatic fibrosis measured
by the FIB-4 index (≥3.25) in a large diverse population of HIV-infected
patients without significant liver disease at baseline (FIB-4<1.45) in care
between January 2000 and March 2014. We used Cox proportional hazards analysis
to examine factors associated with progression to FIB-4 ≥3.25.
RESULTS:
Among
14,198 HIV-infected patients, HCV coinfection (adjusted hazard ratio [aHR] 1.9,
95% CI 1.6-2.1), HBV coinfection (aHR 1.5, 95% CI 1.2-1.8), alcohol use
disorder (aHR 1.4, 95% CI 1.2-1.6) and diabetes (aHR 1.9, 95% CI 1.6-2.3) were
associated with progression to advanced fibrosis in multivariable analysis. In
addition, patients at each lower level of time-varying CD4 count had a
significantly greater risk of progression, with a nearly 7-fold higher risk in
those with CD4 <100 cells/mm (aHR 6.9, 95% CI 5.8-8.3) compared with CD4
≥500 cells/mm. An increasing gradient of risk was also observed among patients
with higher time-varying HIV viral load (VL), with the greatest risk noted with
VL ≥100,000 copies/ml (aHR 2.6, 95% CI 2.2-3.1) compared with VL <500
copies/ml.
CONCLUSION:
Lower
CD4 count and higher HIV VL were significantly associated with progression to
advanced hepatic fibrosis in a dose-dependent manner, independent of the risk
associated with traditional factors: HCV or HBV coinfection, alcohol, and
diabetes. Our findings suggest that early treatment of HIV infection could
mitigate liver disease.
By: Kim HN1, Nance R, Van Rompaey S, Delaney JC, Crane HM, Cachay ER, Geng E, Boswell SL, Rodriguez B, Eron J, Saag M, Moore RD, Kitahata MM.
- 1Department of Medicine, University of Washington
- 2 Department of Epidemiology, University of Washington
- 3 Department of Medicine, University of California San Diego
- 4 Department of Medicine, University of California San Francisco
- 5 Fenway Health, Boston MA
- 6 Department of Medicine, Case Western University
- 7 Department of Medicine, University of North Carolina Chapel Hill
- 8 Department of Medicine, University of Alabama, Birmingham
- 9 Department of Medicine, Johns Hopkins University.
- J Acquir Immune Defic Syndr. 2016 Mar 16.
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