Progression of liver fibrosis in HIV /hepatitis C virus‐coinfected individuals on antiretroviral therapy with early stages of liver fibrosis at baseline
Ramon SanmartinJordi TorArantza SanvisensJ.L. García LópezAntoni JouRoberto MugaIsabel OjangurenEva BarluengaSebastián VidelaRamón PlanasBonaventura ClotetC. Tural
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The aim of the study was to assess the progression of liver fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients with no or mild-to-moderate fibrosis (stages F0-F2).Liver fibrosis was reassessed by transient elastometry (TE) between January 2009 and November 2011 in HIV/HCV-coinfected patients with stage F0-F2 fibrosis in a liver biopsy performed between January 1997 and December 2007. Patients with liver stiffness at the end of follow-up < 7.1 kPa were defined as nonprogressors, and those with values ≥ 9.5 kPa or who died from liver disease were defined as progressors. Cirrhosis was defined as a cut-off of 14.6 kPa. The follow-up period was the time between liver biopsy and TE. Cox regression models adjusted for age, gender and liver fibrosis stage at baseline were applied.The median follow-up time was 7.8 years [interquartile range (IQR) 5.5-10 years]. The study population comprised 162 patients [115 (71%) nonprogressors and 47 (29%) progressors; 19 patients (11.7%) had cirrhosis]. The median time from the diagnosis of HCV infection to the end of follow-up was 20 years (IQR 16.3-23.1 years). Three progressors died from liver disease (1.8%). The variables associated with a lower risk of progression were age ≤ 38 years (hazard ratio (HR) 0.32; 95% confidence interval (CI) 0.16-0.62; P = 0.001], having received interferon (HR 2.18; 95% CI 1.14-4.15; P = 0.017), being hepatitis B virus surface antigen (HBsAg) negative (HR 0.20; 95% CI 0.04-0.92; P = 0.039), and baseline F0-F1 (HR 0.43; 95% CI 0.28-0.86; P = 0.017).A high proportion of patients with stage F0-F2 fibrosis progress to advanced liver fibrosis. Advanced liver fibrosis must be included in the list of diseases associated with aging. Our results support the recommendation to offer HCV antiviral therapy to HIV/HCV-coinfected patients at early stages of liver fibrosis.Keywords:
Hepatitis C
Since hepatitis C virus (HCV) was first identified in 1989, the impact of HCV infection on the HIV-infected population has been steadily increasing. It is now known that HCV affects the course and treatment of HIV disease in coinfected individuals (those infected with both HCV and HIV). Although there are significant data regarding the treatment of HCV in non-coinfected individuals, there are numerous questions that still remain regarding how to monitor and treat HCV infection in the coinfected population. This article reviews the available data regarding treatment of HCV in the coinfected population as well as how these individuals should be monitored, before and during HCV therapy, as well as how to address the numerous side effects associated with HCV treatment. To meet the demands of the coinfected population, HIV nurses must be willing to expand their knowledge to support, educate, assess, and advocate for coinfected individuals.
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Because most patients coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are injection drug users (IDUs) who might have been exposed to multiple HCV genotypes while sharing needles, coinfection with distinct HCV genotypes could be frequent in them. Blood samples from 203 coinfected IDUs who did not respond to at least 24 weeks of interferon (IFN)-based therapies were analyzed. At baseline, 131 patients had HCV genotype 1, 4 had HCV genotype 2, 52 had HCV genotype 3, and 16 had HCV genotype 4. Changes in HCV genotype were not found in any patient when samples obtained before and after HCV therapy were compared. HCV therapy did not appear to select for IFN-resistant HCV genotypes that might have been present at baseline. Coinfection with distinct HCV genotypes is unlikely in former IDUs coinfected with HIV and does not explain the lower efficacy of HCV therapy in this population.
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Objective Objective In HIV-infection, Zn deficiency has been associated with disease progression and increased morbidity and mortality. We studied the association of HIV/HCV co-infection with Zn deficiency and health indicators in HIV+ drug users. Methods After consenting 207 HIV+ drug users,demographic, nutritional, medical and treatment questionnaires and anthropometries were completed. Blood was drawn for CD4 cell counts, HIV viral load, and plasma Zn. Results Of the 207 participants, 37.2% were co-infected with HCV, 72.5% were males and 63% were on HAART. Mean age was 42 years. Plasma Zn was significantly lower in the co-infected group (0.61±0.13 mg/L, p=0.041) as compared to those who were not coinfected (0.67±0.15 mg/L) after adjusting for gender, age, macronutrient intake, and HAART. Participants with low Zn plasma (<0.65mg/L) in the co-infected group as compared to those with higher Zn plasma had significantly greater prevalence of nutrition-related clinical symptoms including nausea and vomiting (22.7% vs. 7.6%, p=0.007), diarrhea (36.4% vs. 21.5%, p=0.035), and significantly greater rate of hospital and ER admissions (31.8% vs. 17.7%, p=0.036). No significant differences were found in body mass index, macronutrient intake, CD4 count, viral load, or HAART between the 2 groups. Conclusions Compared to HIV infection alone, HIV/HCV coinfected drug users had lower plasma zinc, which was associated with greater rate of clinical symptoms and ER and hospital visits. The role of Zn in coinfected patients needs further research. Funded by NIDA
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The majority of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection occurs among persons who inject drugs. Rapid improvements in responses to HCV therapy have been observed, but liver-related morbidity rates remain high, given notoriously low uptake of HCV treatment. Advances in HCV therapy will have a limited impact on the burden of HCV-related disease at the population-level unless barriers to HCV education, screening, evaluation, and treatment are addressed and treatment uptake increases. This review will outline barriers to HCV care in HCV/HIV coinfection, with a particular emphasis on persons who inject drugs, proposing strategies to enhance HCV treatment uptake and outcomes.
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