Without HAART, HIV Infection Accelerates Hepatitis C Disease Progression in Coinfected Individuals

Several prior studies have examined the impact of HIV on the progression of chronic hepatitis C virus (HCV) infection. Though study data are not entirely consistent, the weight of the available evidence suggests that untreated HIV disease significantly accelerates the progression of HCV-related liver disease.

The objective of the current retrospective study by Chinese researchers, published in the February 28, 2009 issue of World Journal of Gastroenterology, was to analyze the influence of HIV infection on the course of HCV infection.

The authors performed a meta-analysis to quantify the effect of HIV coinfection on liver disease progression in patients with chronic hepatitis C. Searching the PUBMED, EMBASE, and CBM databases, they collected published studies in the English or Chinese language medical literature involving cohorts of HIV negative and HIV positive individuals coinfected with HCV.

Data were drawn independently from relevant studies by 2 investigators and were used in a fixed-effect meta-analysis to determine the difference in the course of HCV infection between the 2 groups.

Results

29 trails involving a total of 16,750 patients were identified that included an outcome of histological liver fibrosis or cirrhosis, decompensated liver disease, hepatocellular carcinoma, or death.

These studies yielded an adjusted odds ratio (OR) for the combined outcomes of 3.40.

Overall, people with HIV were about 3 times more likely to progress to advanced HCV-related liver disease or death than HIV negative individuals.

Looking at the separate outcomes, the pooled odds ratios were:

Decompensated liver disease: OR 5.45;

Death: OR 3.60;

Histological fibrosis/cirrhosis: OR 1.47;

Hepatocellular carcinoma: OR 0.76.

In conclusion, the study authors wrote, "Without highly active antiretroviral therapy (HAART), HIV accelerates HCV disease progression, including death, histological fibrosis/cirrhosis, and decompensated liver disease."

However, they continued, "The rate of hepatocellular carcinoma is similar" in chronic hepatitis C patients who were HIV positive or negative.

It is worth noting that some more recent studies looking at HIV positive individuals on HAART with relatively high CD4 cell counts suggest that coinfected people with well-controlled HIV disease and well-preserved immune function may fare nearly as well as HIV negative people.

Department of Infectious Diseases, Zhongnan Hospital, Wuhan University, Hubei Province, China.

3/10/09

Reference
LP Deng, XE Gui, YX Zhang. Impact of human immunodeficiency virus infection on the course of hepatitis C virus infection: A meta-analysis. World Journal of Gastroenterology 15(8): 996-1003. February 28, 2009.

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