Abstract
BackgroundLiver-related deaths represent the leading cause of mortality among patients with HIV/HCV-co-infection, and are mainly related to complications of fibrosis and portal hypertension. In this study, we aimed to evaluate the structural changes by the assessment of extracellular matrix (ECM) derived degradation fragments in peripheral blood as biomarkers for fibrosis and portal hypertension in patients with HIV/HCV co-infection.MethodsFifty-eight patients (67% male, mean age: 36.5 years) with HIV/HCV-co-infection were included in the study. Hepatic venous pressure gradient (HVPG) was measured in forty-three patients. The fibrosis stage was determined using FIB4 -Score. ECM degraded products in peripheral blood were measured using specific ELISAs (C4M, MMP-2/9 degraded type IV collagen; C5M, MMP-2/9 degraded type V collagen; PRO-C3, MMP degraded n-terminal propeptide of type III collagen).ResultsAs expected, HVPG showed strong and significant correlations with FIB4-index (rs = 0.628; p = 7*10−7). Interestingly, PRO-C3 significantly correlated with HVPG (rs = 0.354; p = 0.02), alanine aminotransferase (rs = 0.30; p = 0.038), as well as with FIB4-index (rs = 0.3230; p = 0.035). C4M and C5M levels were higher in patients with portal hypertension (HVPG>5 mmHg).ConclusionPRO-C3 levels reflect liver injury, stage of liver fibrosis and degree of portal hypertension in HIV/HCV-co-infected patients. Furthermore, C4M and C5M were associated with increased portal pressure. Circulating markers of hepatic ECM remodeling might be helpful in the diagnosis and management of liver disease and portal hypertension in patients with HIV/HCV coinfection.
Highlights
Combined antiretroviral treatment is able to control the HIV replication in the majority of HIV patients, and thereby reduce mortality [1,2]
All patients were treated with Combined antiretroviral treatment (cART) and HIV viral load was under detection level
hepatic venous pressure gradient (HVPG) correlated with FIB-4 index, liver stiffness, and inversely with platelet counts (Figure S1)
Summary
Combined antiretroviral treatment (cART) is able to control the HIV replication in the majority of HIV patients, and thereby reduce mortality [1,2]. While a decrease of AIDS-related deaths are noted, mortality related to chronic liver diseases is steadily increasing in HIV patients [3,4,5]. 24% of non-AIDS related deaths in HIV-infected patients are due to end-stage liver disease (ESLD), with 66% being attributed to HCV co-infection and 17% to HBV co-infection [5]. This represents an important socioeconomic problem, given the fact that more than 30% of HIV-patients in Europe and USA are co-infected [4]. Liver-related deaths represent the leading cause of mortality among patients with HIV/HCV-co-infection, and are mainly related to complications of fibrosis and portal hypertension. We aimed to evaluate the structural changes by the assessment of extracellular matrix (ECM) derived degradation fragments in peripheral blood as biomarkers for fibrosis and portal hypertension in patients with HIV/HCV co-infection
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