Predictors of liver fibrosis in HIV-infected patients with chronic hepatitis C virus (HCV) infection:: Assessment using transient elastometry and the role of HCV genotype

Background. Liver fibrosis is accelerated in patients coinfected with hepatitis C virus ( HCV) and human immunodeficiency virus ( HIV). The reasons for this faster liver disease progression are unclear, although higher plasma HCV RNA levels and distinct HCV genotype distribution in this population, compared with in HCV-monoinfected subjects, could play a role. Methods. Liver fibrosis was assessed using elastometry in all consecutive HIV-infected patients with chronic hepatitis C who attended our institution ( Hospital Carlos III, Madrid) during the past 12 months. Hepatic stiffness was measured in kiloPascal units ( kPa) and was interpreted on the basis of Metavir score: no or mild fibrosis ( score, F0 - F1) when liver stiffness is <= 7.1 kPa, and fibrosis with septa or cirrhosis ( F2 - F4) when > 7.1 kPa. Results. A total of 283 patients ( 71% were male; mean age, 42 years; 94% were injection drug users and 94% were receiving antiretrovirals; mean CD4 cell count, 554 cells/mu L; 72% with plasma HIV RNA level of >= 50 copies/mL) were analyzed. The mean alanine aminotransferase level was 68 IU/L, and the mean plasma HCV RNA level was 5.9 log IU/mL. HCV genotype distribution was as follows: genotype 1, 60% of patients; genotype 2, 2%; genotype 3, 26%; and genotype 4, 12%. Overall, 164 ( 58%) of the patients had scores indicating advanced liver fibrosis ( F2 - F4), as determined using elastometry. In the univariate and multivariate analyses, respectively, a significant odds ratio ( OR) for score F2 - F4 was found for HCV genotype 3, compared with the other genotypes ( OR, 1.9 [ 95% confidence interval {CI}, 1.1 - 3.4] vs. 4.3 [ 95% CI, 1.4 - 13.3]); for older age ( OR, 1.1 [ 95% CI, 1.03 - 1.17] vs. 1.1 [ 95% CI, 1.01 - 1.25]); and for elevated alanine aminotransferase levels ( OR, 1.02 [ 95% CI, 1.01 1.03] vs. 1.03 [ 95% CI, 1.01 - 1.04]). Although patients with HCV genotype 1 had higher mean serum HCV RNA levels than did those with HCV genotype 3 ( 6.1 log IU/mL vs. 5.7 log IU/mL;), patients with HCV genotype Pp. 01 3 tended to have F2 - F4 scores more frequently than did those with HCV genotype 1 ( 69% vs. 58%; P p not significant). Conclusions. HCV genotype 3, older age, and elevated alanine aminotransferase levels are independent predictors of advanced liver fibrosis in HCV-HIV-coinfected patients.