Abstract
BackgroundLiver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to co-infection with hepatitis B or C. The impact of other risk factors, including prolonged exposure to combined antiretroviral therapy (cART) is poorly understood. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]).MethodsIn 202 consecutive HIV-infected individuals (159 men; mean age 47 ± 9 years; 35 with hepatitis-C-virus [HCV] co-infection), TE and FT were performed. Repeat TE examinations were conducted 1 and 2 years after study inclusion.ResultsSignificant liver fibrosis was present in 16% and 29% of patients, respectively, when assessed by TE (≥ 7.1 kPa) and FT (> 0.48). A combination of TE and FT predicted significant fibrosis in 8% of all patients (31% in HIV/HCV co-infected and 3% in HIV mono-infected individuals). Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals. Overall, factors independently associated with significant fibrosis as assessed by TE (OR, 95% CI) were co-infection with HCV (7.29, 1.95-27.34), chronic AST (6.58, 1.30-33.25) and γ-GT (5.17, 1.56-17.08) elevation and time on dideoxynucleoside therapy (1.01, 1.00-1.02). In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).ConclusionsChronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART. However, only a small subset had significant fibrosis as predicted by TE and FT. There was no evidence for fibrosis progression during follow-up TE examinations.
Highlights
Liver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to coinfection with hepatitis B or C
While on the one hand, longterm combined antiretroviral therapy (cART) was found to be a protective factor for liver fibrosis in some studies [6,7], other findings suggest that exposure to dideoxynucleosides and other nucleoside analog reverse-transcriptase inhibitors (NRTIs) is associated both with chronic elevation of aspartate aminotransferase (AST) and/or ALT levels and liver fibrosis [5,8]
Several studies indicate that long-term cART may worsen liver fibrosis in patients with HIV/hepatitis C virus (HCV) co-infection and that this effect is mostly seen with NRTIs
Summary
Liver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to coinfection with hepatitis B or C. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]). Effective and long-term combination antiretroviral therapy (cART) has substantially decreased morbidity and mortality in human immunodeficiency virus (HIV) infected individuals [1,2]. Chronic alanine aminotransferase (ALT) elevations have been observed in 16% of HIV mono-infected individuals during cART but their clinical significance over time is poorly understood [5]. While on the one hand, longterm cART was found to be a protective factor for liver fibrosis in some studies [6,7], other findings suggest that exposure to dideoxynucleosides and other nucleoside analog reverse-transcriptase inhibitors (NRTIs) is associated both with chronic elevation of aspartate aminotransferase (AST) and/or ALT levels and liver fibrosis [5,8]. Blood tests (e.g., AST-to-platelet ratio index [APRI] and Fibrotest [FT]) have been developed to noninvasively predict the extent of liver fibrosis in a variety of liver diseases [10,11]
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