Liver fibrosis progression in human immunodeficiency virus and hepatitis Cvirus coinfected patients

The natural history of hepatitis C virus (HCV) infection in human immunodef iciency virus (HIV)-infected patients has never been studied according to t he concept of liver fibrosis progression. The aim of this work was to asses s the fibrosis progression rate in HIV-HCV coinfected patients and in patie nts infected by HCV only. A cohort of 122 HIV-HCV coinfected patients was c ompared with a control group of 122 HIV-negative HCV-infected patients. Gro ups were matched according to age, sex, daily alcohol consumption, age at H CV infection, and duration and route of HCV infection. The fibrosis progres sion rate was defined as the ratio between fibrosis stage (METAVIR scoring system) and the HCV duration. The prevalence of extensive liver fibrosis (M ETAVIR fibrosis scores 2, 3, and 4) and moderate or severe activity were hi gher in HIV-infected patients (60% and 54%, respectively) than in control p atients (47% and 30%, respectively; P < .05 and P < .001, respectively). Th e median fibrosis progression rate in coinfected patients and in control pa tients was 0.153 (95% confidence interval [CI], 0.117-0.181) and 0.106 (95% CI, 0.084-0.125) fibrosis units per year, respectively (P < .0001). HIV se ropositivity (P < .0001), alcohol consumption (>50 g/d, P = .0002), age at HCV infection (<25 years old, P < .0001), and severe immunosuppression (CD4 count less than or equal to 200 cells/mu L, P < .0001) were associated wit h an increase in the fibrosis progression rate. In coinfected patients, alc ohol consumption (>50 g/d), CD4 count (less than or equal to 200 cells/mu L ), and age at HCV infection (<25 years old) (P < .0001, respectively) were associated with a higher fibrosis progression rate. HIV seropositivity acce lerates HCV-related liver fibrosis progression. In coinfected patients, a l ow CD4 count, alcohol consumption rate, and age at HCV infection are associ ated with a higher liver fibrosis progression rate.