Author/Authors :
Schiavini, Monica Department of Infectious Diseases - L. Sacco Hospital, Milan, Italy , Angeli, Elena Department of Infectious Diseases - L. Sacco Hospital, Milan, Italy , Mainini, Annalisa Department of Infectious Diseases - L. Sacco Hospital, Milan, Italy , Uberti-Foppa, Caterina Division of Infectious Diseases - San Raffaele Scientific Institute, Milan, Italy , Zerbi, Pietro Department of Pathology - L.Sacco Hospital, Milan, Italy , Sagnelli, Caterina Division of Infectious Diseases - San Raffaele Scientific Institute, Milan, Italy , Cargnel, Antonietta AIDS-Aid Foundation, Milan, Italy , Vago, Gianluca Department of Pathology - L.Sacco Hospital, Milan, Italy , Giorgio Duca, Pier Medical Statistic Unit - Preclinical Science Department - Milan University, Milan, Italy , Giorgi, Riccardo Department of Infectious Diseases - L. Sacco Hospital, Milan, Italy , Rizzardini, Giuliano Department of Infectious Diseases - L. Sacco Hospital, Milan, Italy , Gubertini, Guido Department of Infectious Diseases - L. Sacco Hospital, Milan, Italy
Abstract :
Background: Chronic hepatitis C is more aggressive during HIV infection. Available data about risk factors of liver fibrosis in HIV/HCV co-infected patients derive from studies based on a single liver biopsy.
Objectives: To evaluate the risk factors of liver fibrosis progression (LFP) and to investigate the role of antiretroviral therapy (ARV) in HIV/HCV patients who underwent paired liver biopsy.
Patients and Methods: We retrospectively studied 58 patients followed at two Infectious Diseases Departments in Northern Italy during the period 1988-2005. All specimens were double-blinded and centrally examined by two pathologists. LFP was defined when an increase of at least one stage occurred in the second biopsy, according to the Ishak-Knodell classification.
Results: In a univariate analysis, serum levels of alanine aminotransferase (ALT) > 150 IU/L at the first biopsy (P = 0.02), and a > 20% decrease in CD4+ cell count between the two biopsies (P = 0.007), were significantly associated with LFP. In multivariate analysis, a > 20% decrease in CD4+ cell count remained independently associated to LFP (Odds Ratio, 3.99; 95% confidence interval, 1.25-12.76; P < 0.02). Analysis of life survival curves confirmed the correlation between CD4+ cell count and LFP.
Conclusions: Our findings highlight that in HIV/HCV coinfected patients, an effective antiretroviral therapy that assures a good immune-virological profile contributes to reducing the risk of LFP.
