Wednesday, March 23, 2016

Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis

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.

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.

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.

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.

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  • 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.
  •  2016 Mar 16. 

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