February 27, 2013
Researchers found that HIV infection promotes the progression of liver disease in people coinfected with the hepatitis C virus (HCV). David Thomas, MD, of Johns Hopkins School of Medicine and colleagues conducted a prospective observational study in a cohort of HCV-infected people. The researchers were aware that although people with HIV have been reported to develop age-related disease at a younger age, it has not been determined whether the observations are caused by HIV infection or other risk factors.
The researchers used data from the AIDS Linked to the IntraVenous Experience (ALIVE) cohort of current and former injection drug users in Baltimore. They compared liver fibrosis severity by age (assessed every six months by liver stiffness measurements) among HCV-infected individuals with and without HIV who were being followed up over time with the same protocol.
Of the 1,176 participants (median age of 49 years), 34 percent were coinfected with HIV. Participants had 5,634 liver fibrosis measurements throughout 2.9 years of follow-up. Individuals with both HCV and HIV infection had significantly more cirrhosis or clinically significant fibrosis without cirrhosis at the beginning of the study. Liver fibrosis was independently associated with older age and HIV infection. Using a multivariate model, researchers calculated the expected liver fibrosis value by age and found that, with age held constant, fibrosis was 1.17 to 2.02 kilopascals greater in individuals with HIV than those without. This means that HIV-infected people had liver fibrosis measurements equal to those of uninfected individuals approximately 9.2 year older. Also, liver fibrosis among HIV-infected individuals was associated with lower nadir or current counts of CD4-positive T cells and with higher levels of HIV RNA.
The full report, "HIV, Age, and the Severity of Hepatitis C VirusRelated Liver Disease: A Cohort Study," was published online in the journal Annals of Internal Medicine (February 26, 2013).
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