Hepatitis C is more severe in drug users with human immunodeficiency virusinfection

Drug users with chronic hepatitis C virus (HCV) infection are frequently co -infected with human immunodeficiency virus-1 (HIV-1), but it is still not clear whether HIV-1 worsens the natural history of hepatitis C. To investig ate this, we conducted a multicentre observational study in 163 drug addict s with histologically documented hepatitis C, 92 of whom were also infected with HIV-1: 25 (27%) were CDC stage II, 53 (58%) were CDC stage III and 14 (15%) were CDC stage IV. Eighty-eight (54%) patients had chronic hepatitis (CH) with minimal activity, 28 (17%) had CH with moderate activity, 40 (25 %) had CH with severe activity and seven (4%) had active cirrhosis. Twenty- one HIV-negative patients and 15 HIV-positive patients admitted to alcohol abuse (29% vs 16%, P=0.0665). Liver disease was more severe in HIV-positive patients than in HIV-negative ones (P=0.0198): 34 HIV-positive patients an d 13 HIV negatives had severe CH and cirrhosis. These two severe liver dise ases were seen more often in HIV-positive patients with a history of alcoho l abuse than in HIV-negative patients (10 out of 16 vs seven out of 21). Ag e, alcohol abuse and distribution of the histological categories of liver d isease were statistically different in HIV-infected and HIV-uninfected pati ents. Multivariate analysis showed that age, alcohol abuse and serum antibo dies to HIV were independently associated with severe CH or cirrhosis. Thus , HIV may enhance the risk of severe liver disease in drug users with hepat itis C, independently of the degree of immune dysfunction. Alcohol abuse ma y contribute independently, aggravating the cause of HCV-dependent liver di sease.