Clinical progression of hepatitis C virus–related chronic liver disease in human immunodeficiency virus–infected patients undergoing highly active antiretroviral therapy

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Abstract
Little is known about the natural history of liver disease in human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected subjects under highly active antiretroviral therapy (HAART). The objectives of this study were to obtain information about the mortality, the incidence of hepatic decompensations, and the predictors thereof in this population. In a multicenter cohort study, the time to the first hepatic decompensation and the survival of 1,011 antiretroviral naïve, HIV/HCV-coinfected patients who started HAART and who were followed prospectively were analyzed. After a median (Q1-Q3) follow-up of 5.3 (2.9–7.1) years, 59(5.83%) patients developed a hepatic decompensation and 69 (6.82%) died, 30 (43%) of them because of liver disease. The factors independently associated [HR (95% CI)] with the occurrence of hepatic decompensations were age older than 33 years [2.11 (1.18–3.78)], female sex [2.11 (1.07–4.15)], Centers for Disease Control stage C [2.14 (1.24–3.70)], a diagnosis of cirrhosis at baseline [10.86 (6.02–19.6)], CD4 cell gain lower than 100/mm3 [4.10 (2.18–7.69)] and less than 60% of the follow-up with undetectable HIV viral load [5.23 (2.5–10.93)]. Older age [2.97 (1.18–7.50)], lack of HCV therapy [11.32 (1.44–89.05)], hepatitis D virus coinfection [16.15 (2.45–106.48)], a diagnosis of cirrhosis at recruitment [13.69 (5.55–34.48)], hepatic encephalopathy [62.5 (21.27–200)] and lower CD4 cell gain [3.63 (1.45–9.09)] were associated with mortality due to liver failure. Conclusion: End-stage liver disease is the primary cause of death in HIV/HCV-coinfected patients under HAART. Higher increase of CD4 cell counts, lack of markers of serious liver disease and therapy against HCV are factors associated with better hepatic outcome. (Hepatology 2007.)