IMMUNOSUPPRESSION MAY LEAD TO PROGRESSION OF HEPATITIS-C VIRUS-ASSOCIATED LIVER-DISEASE IN HEMOPHILIACS COINFECTED WITH HIV

Objective: The aim of this study was to examine the interaction betwee n HIV and hepatitis C virus (HCV) in hemophiliacs coinfected with the viruses and to investigate the possible relationship between immunosup pression and liver failure. Methods: To identify risk factors for impe nding liver failure in hemophiliacs coinfected with HIV and HCV, we an alyzed clinical and laboratory parameters, including CD4 count, aminot ransferases (ALT, AST), cholinesterase, alkaline phosphatase, bilirubi n, and gamma-glutamyltransferase, during 3 yr of follow-up (1990-1993) in four groups of patients: hemophiliacs with progressive immunodefic iency who were coinfected with HCV and HIV (group A, n = 49); hemophil iacs with stable immune function who were sero-positive for HIV and HC V (group B, n = 95); hemophiliacs who were infected with HCV but not H IV (group C, n = 72); and homosexuals with progressive immunodeficienc y who were infected with HIV but not HCV (group D, n = 24). Results: U nivariate analysis of data for group A showed a significant rise in ga mma-glutamyltransferase and alkaline phosphatase (p < 0.01) that was n ot seen in groups B, C, and D. In a multivariate Cox regression analys is, age (odds ratio, 1.054 per yr; 95% confidence interval, 1.014-1.09 6 per yr), decline in CD4 count (odds ratio, 1.063 per cell/mu l; 95% confidence interval, 1.037-1.091 per cell/mu l), and alkaline phosphat ase level (odds ratio, 1.012 per U/L; 95% confidence interval, 1.002-1 .021 per U/L) emerged as independent determinants of death. Conclusion s: Our data suggest that progressive immune dysfunction in hemophiliac s coinfected with HIV and HCV may influence progression of liver failu re. In these patients cholestasis is an additional prognostic marker f or survival that may reflect both exhausted immunity and impaired live r function.