Liver fibrosis progression is related to CD4 cell depletion in patients coinfected with hepatitis C virus and human immunodeficiency virus.

A total of 204 patients with liver biopsy‐proven hepatitis C virus (HCV) infection, 84 with and 120 without human immunodeficiency virus (HIV) coinfection, were studied, to evaluate variables possibly associated with the stage of liver fibrosis. All patients were injection drugs users, with a mean age of 32 years and an estimated duration of HCV infection of 12 years. Twenty-four patients (11%) had many fibrous septa with (5%) or without (6%) cirrhosis, 56 (27%) had few fibrous septa, and 124 (60%) had no fibrous septa. In all patients, an association was found between CD4 cell counts !500 cells/mm 3 and the presence of many fibrous septa (odds ratio, 3.2; ), independent of HIV infection and other factors. These results P p .037 suggest that HIV infection‐induced CD4 depletion is independently associated with the severity of liver fibrosis in chronic HCV infection. Because hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share common transmission pathways, HIVHCV coinfection is common, particularly in patients with hemophilia and in injection drug users [1]. The increased survival brought on by combination antiretroviral therapies in HIVinfected patients [2] has uncovered the role that hepatitis C plays in causing morbidity and mortality. In HIV-uninfected patients, hepatitis C may progress to fibrosis and cirrhosis and is associated with the estimated duration of HCV infection, age at infection, sex, and alcohol use [3]. Simultaneous coinfection with HIV and HCV results in more rapid progression toward liver failure [4]. Retrospective analysis of HIV-infected and -uninfected hemophilic cohorts infected with HCV revealed an accelerated rate of severe liver disease in HIV-infected patients in association with severe CD4 cell depletion [4]. We retrospectively examined the relationship between HIV-induced CD4 depletion with HCV-associated liver fibrosis in a large series of patients with chronic hepatitis C with and without HIV coinfection.