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Factors associated with improvement of liver fibrosis in a large cohort of HIV-infected patients followed for 5 years
J.V. Fernández Montero, P. Labarga, P. Barreiro, E. Vispo, F. Blanco, J. Medrano, J. Gonzalez-Lahoz, V. Soriano
Hospital Carlos III, Infectious Diseases, Madrid, Spain
Background: Liver disease is frequent cause of complications among HIV infected individuals. The availability of non-invasive tools to determine liver fibrosis (i.e. Fibroscan, FS) allows to follow prospectively large numbers of patients.
Methods: A prospective cohort of HIV infected patients examined by FS was established in 2004. In subjects with 2 FS examinations separated by ≥18 months, factors related with fibrosis regression (FR) were analyzed in 2008. FR was defined as a decrease ≥30% in liver stiffness in patients with >9.2 KPa at FS1 (Metavir F3-F4) between FS1 and FS2. Metabolic and HIV related parameters were prospectively recorded at the time of FS1, and every 3 months up to FS2. The presence and treatment of Hepatitis B and C viruses, antiretroviral treatment characteristics and alcohol abuse were assessed.
Results: A total of 632 HIV-infected patients (median age 45 years, 78% males, 63% IDUs, median BMI 23 kg/m2, median CD4 count 494 cells/µL, HCV-RNA+ 72%, HBsAg+ 10%, alcohol abuse 9%), had 2 paired FS examinations separated by a median of 27 (19-33) months. At FS1 Metavir F3-F4 was detected in 193 (30%) patients, and at FS2 65 (10%) patients had criteria for FR. As compared with patients without FR, the FR group had a lower percentage of males 67.7 vs 83.6% (p=0.01) and higher percentage of patients treated for hepatitis C 81.3 vs 44.2% (p< 0.001). Patients with FR had a greater decrease in glycemia between the two FS (-3.2 vs 1.9 mg/dL [p=0.04]) and lower HIV-RNA levels at FS2 (1.8 vs 2.1 log copies/mL [p=0.001]). Factors related (OR, 95% CI) with FR in multivariate analysis were treatment of hepatitis C (3.8 [1.2-12.1], p=0.02), and glucemic improvement (1.05 [1.03-1.09], p=0.03).
Conclusions: Treatment of hepatitis C and better control glycose metabolism are associated with improvement in liver fibrosis in HIV-infected patients.
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