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Factors influencing liver fibrosis and necroinflammation in HIV/HCV coinfection and HCV monoinfection

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Abstract

Objectives

To define differences in liver histology between HIV/HCV coinfection and HCV monoinfection, and to investigate possible causative factors.

Methods

Liver biopsies (LBs) from 440 consecutive HIV/HCV-coinfected patients (Group HIV/HCV) and 374 consecutive HCV-monoinfected patients (Group HCV) were evaluated for necroinflammation and fibrosis (Ishak) by a pathologist unaware of the clinical and laboratory data. All patients were HBsAg-negative, with no history of alcohol abuse and naïve to anti-HCV treatment. At LB, 78.4 % of patients in Group HIV/HCV were on an antiretroviral regimen.

Results

HIV/HCV-coinfected patients compared to the HCV-monoinfected patients were younger (p < 0.0001), more frequently males (p < 0.0001), and had HCV genotype 3 (p < 0.0001); they showed a good immunological condition (CD4+ cell count: 518 ± 166 cells/mm3). Patients in Group HIV/HCV more frequently showed a fibrosis score ≥4 (27.5 vs. 20.6 %, p < 0.05) and a necroinflammation score ≥9 (25.9 vs. 13.4 %; p < 0.0001). The prevalence of patients with fibrosis score ≥4 was significantly higher in older age classes in both Group HIV/HCV (p < 0.005) and Group HCV (p < 0.05). A necroinflammation score ≥9 was significantly higher in older age classes only in Group HIV/HCV (p < 0.05). A multivariate analysis for Group HIV/HCV revealed that the patient age and nadir of CD4+ cell count were independently associated to higher degrees of fibrosis, the patient age and antiretroviral treatment were associated to higher degrees of necroinflammation, and HCV genotype 3 was associated to higher degrees of steatosis.

Conclusion

The data suggest a need for early anti-HCV treatment in both HCV-monoinfected and HIV/HCV-coinfected patients.

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Acknowledgments

The authors thank Dr. Giuseppe Signoriello from the Department of Mental Health and Public Medicine, Section of Medical Statistics, Second University of Naples, Naples, Italy for the revision of the statistical analysis.

Conflict of interest

None.

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Authors and Affiliations

  1. Clinic of Infectious Diseases and Department of Pathology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    C. Sagnelli, C. Uberti-Foppa, L. Albarello, C. Doglioni & A. Lazzarin

  2. Department of Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University of Naples, Naples, Italy

    C. Sagnelli

  3. Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, via L. Armanni, 3, 80135, Naples, Italy

    G. Pasquale, S. De Pascalis, N. Coppola & E. Sagnelli

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  1. C. Sagnelli
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Correspondence to E. Sagnelli.

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Sagnelli, C., Uberti-Foppa, C., Pasquale, G. et al. Factors influencing liver fibrosis and necroinflammation in HIV/HCV coinfection and HCV monoinfection. Infection 41, 959–967 (2013). https://doi.org/10.1007/s15010-013-0502-3

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  • DOI: https://doi.org/10.1007/s15010-013-0502-3

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