Serious Liver Disease Persists in HCV Patients with HIV Co-Infection Receiving Antiretroviral Therapy

Patients with co-infection are 80% more likely to have serious liver disease than patients with hepatitis C alone, study finds.

Co-infection with HIV in addition to hepatitis C virus (HCV) carries a higher risk of serious liver disease in patients even when they are receiving antiretroviral therapy (ART) than that found in patients with HCV alone, according to a new study by researchers at the University of Pennsylvania.

The study, published in the March 18, 2014, issue of Annals of Internal Medicine, compared outcomes in patients co-infected with HIV and HCV who were undergoing ART treatment with patients who have chronic HCV alone. HCV co-infection occurs in 10% to 30% of HIV-infected patients, according to the study authors.

“The course of chronic HCV is accelerated in patients co-infected with HIV, with more rapid progression of liver fibrosis than in HCV-monoinfected patients,” the authors write. “Consequently, HCV-related liver complications, particularly hepatic decompensation … have emerged as important causes of illness in co-infected patients.”

The study examined data from 4280 co-infected patients receiving ART and 6079 patients with HCV only, between the years of 1997 and 2010. The researchers found that co-infected patients had a rate of decompensated cirrhosis 80% higher than did HCV-only patients. The study also found that co-infected patients who had controlled HIV in response to ART still carried a rate of serious liver disease 60% higher than did patients with HCV only.

Additionally, the study revealed that co-infected patients with minimal or no fibrosis at baseline still had a higher risk for decompensation than did monoinfected patients. Prior research has suggested that progression of liver fibrosis associated with HCV is slowed by ART through a reduction in HIV-related inflammation and immune dysfunction. However, the authors of the current study indicate that it is unclear whether severe liver events in co-infected patients receiving ART are similar to those in HCV-only patients

“[T]he determinants of hepatic decompensation among co-infected patients receiving ART are unknown,” the authors write. “Determination of these factors could help define the mechanisms of decompensation in co-infected patients and could suggest interventions to reduce the risk for end-stage liver disease in this population.”

Possible causes of hepatic decompensation in co-infected patients, the authors note, include “HIV-related immune dysregulation, HIV-mediated depletion of CD4 cells in the gastrointestinal tract with resultant microbial translocation, oxidative stress related to co-infection with HIV and HCV, and HIV-induced hepatocyte apoptosis.”

A higher rate of decompensation was also found in co-infected patients with baseline advanced liver fibrosis, severe anemia, diabetes, or non-black race, according to the study.

As a result of these findings, the authors note that early treatment of co-infected patients is vital to reduce the risk of serious liver damage.

“Our results suggest that serious consideration should be given to initiating hepatitis C treatment in patients co-infected with HIV and hepatitis C—particularly among those with advanced liver fibrosis or cirrhosis—in order to try to reduce the risk of serious, potentially life-threatening liver complications,” said study lead author Vincent Lo Re III, MD, MSCE, assistant professor of medicine and epidemiology at the University of Pennsylvania, in a press release. “By taking action sooner, we may be able to reduce the risk of advanced liver disease in co-infected patients.”