France -- Studying End-Stage Liver Disease

If left untreated, HCV infection causes healthy liver tissue to be replaced with scar tissue in a process called fibrosis. Eventually, as fibrosis spreads, the liver becomes increasingly dysfunctional and the health of the body is affected as this vital organ withers. At that point, end-stage liver disease (ESLD) sets in as complications such as serious bacterial infections, internal bleeding, severe fatigue, neurocognitive problems and, in some cases, liver cancer occurs.

Researchers in France have been monitoring the health of 310 participants co-infected with HIV and HCV who had extensive liver damage (cirrhosis). They found that participants who were most likely to develop serious complications of ESLD had the following factors:

• elevated levels of alpha-fetoprotein in their blood
• lower CD4+ cell counts -- an average of 275 cells compared to people who had higher counts (395 cells)
• more likely to rent their housing rather than own; this may reflect poorer socioeconomic conditions

After five years of monitoring, about 16% of participants had developed ESLD.

Between 2006 and 2011, selected causes of death in the group were distributed as follows:

• HCV-related, including liver cancer -- 43%
• non-AIDS-related cancer -- 14%
• AIDS -- 10%
• cardiovascular disease -- 8%
• non-AIDS-related infections -- 8%
• lung problems -- 4%
• overdose and suicide -- 5%

Even among a subset of participants who were able to clear HCV because of treatment, the risk of developing liver cancer remained, perhaps because of extensive liver damage (cirrhosis).

Bear in mind that this study was observational; it was not a randomized, controlled clinical trial, and its conclusions may therefore be inadvertently biased. But the study shows the need for HCV-positive people to access therapy for this infection much earlier in the course of their illness before extensive liver damage occurs.

Reference

Salmon D, Pambrun E, Winnock M, et al. Incidence of end stage liver disease (ESLD) in HIV/HCV infected patients in France "HEPAVIR ANRS C013." In: Program and abstracts of the 8th International Workshop on HIV and Hepatitis Co-infection, 30 May - 1 June 2012, Madrid, Spain. Abstract 0_02A.