Spotlight Series on Hepatitis C

Liver Fibrosis in HIV/Hepatitis C Coinfection: HIV Protease Inhibitors May Be Protective

August 24, 2001

This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

A study of 182 patients at a major hospital in France suggests that HIV protease inhibitors may help to reduce liver fibrosis and cirrhosis in patients with both HIV and hepatitis C.(1)

This study, conducted in patients with both hepatitis C and HIV, was done to determine if protease inhibitors were really harmful to such patients, as had been reported in some cases. In fact, the opposite was found; use of protease inhibitors was associated with significantly less liver damage in this study. No one knows why, although the authors suggested several possible mechanisms. This new study is the first large, long-term follow-up of coinfected patients which included liver biopsy data -- which may help explain why it found different results.

The new study, published in the August 2000 Hepatology, analyzed a cohort of patients who had been treated at the hospital between 1995 and 2000, and on whom careful medical records had been kept. A statistical analysis found four independent predictors of progression to cirrhosis (severe scarring of the liver): absence of protease inhibitor therapy (relative risk 4.74), heavy alcohol use (greater than or equal to 50 grams per day -- about 5 drinks a day -- relative risk 4.71), CD4 count under 200 (relative risk 2.74), and age greater than 20 years at the time of hepatitis C infection (relative risk 2.74).

The protective effect of antiretroviral treatment was found only for protease inhibitors, not for nucleoside analog drugs. (There were not enough patients treated with NNRTIs, such as nevirapine or efavirenz, to make a comparison.)

The authors suggested that using protease inhibitors in HIV therapy, reducing alcohol consumption, and keeping CD4 counts high might be beneficial in coinfected patients.

This study was limited because it was not a randomized trial where patients were randomly assigned to use protease inhibitors or not, with long-term follow-up with liver biopsy. The authors noted that such a trial would be impossible for both ethical and practical reasons.


  1. Benhamou Y., Di Martino V., Bochet M., and others. Factors affecting liver fibrosis in human immunodeficiency virus -- and hepatitis C virus-coinfected patients: Impact of protease inhibitor therapy. Hepatology. August 2001; volume 34, pages 283-287.


For more information on hepatitis C and coinfection with HIV, see The Hepatitis Report by Michael Marco and Jeff Schouten, available at (click on "HIV/HCV Coinfection").

ISSN # 1052-4207

Copyright 2001 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

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