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Fibrosis progression common in HIV/HCV coinfection; linked to serum transaminase

Elevated serum transaminase levels are potential noninvasive markers of fibrosis, which is common and can progress rapidly among patients coinfected with hepatitis C and HIV, according to recent results.

In a prospective cohort study, researchers evaluated fibrosis progression in 435 liver biopsy pairs collected from 282 noncirrhotic patients with HIV/HCV coinfection between July 1993 and December 2008. Median interval between biopsies was 2.5 years. Ninety-nine percent of participants were treatment-naive and had HCV genotype 1 (93.4%); the majority were African-American (84.8%) and male (67.7%).

Most participants had no or minimal fibrosis on initial biopsy (86%), with METAVIR stage 2 fibrosis in 11% and stage 3 in 2.8%. Fibrosis progression between first and second biopsy occurred in 34% of patients and biopsy pairs. Progression of two or more METAVIR stages occurred in 8.9% of cases.

Progression patients had higher median AST (P<.0001) and ALT levels (P=.0004) compared with those without progression, and more biopsy pairs indicating progression had ALT (P=.0002) and AST (P<.0001) values more than 2.5 times the upper limit of normal.

Multivariate analysis adjusting for confounders at baseline and between biopsies indicated significant associations between progression and elevated AST (aOR=3.34; 95% CI, 1.77-6.31) and ALT (aOR=2.18; 95% CI, 1.2-3.96), hepatic steatosis (aOR=1.78; 95% CI, 0.95-3.33), diabetes (aOR=1.56; 95% CI, 0.9-2.68) and higher BMI (aOR=1.04; 95% CI, 0.99-1.09 per unit increase).

Monica A. Konerman

“These findings stress the importance of serial monitoring of coinfected patients, even those with minimal disease on initial assessment … [and] suggest possible modifiable risk factors that may be amenable to intervention,” researcher Monica A. Konerman, MD, gastroenterology fellow at the University of Michigan, told Healio.com. “Clinicians may be most interested in the correlation between persistently elevated transaminase levels and fibrosis progression, as this data is readily available and routinely collected. As such, it may serve as a useful tool to noninvasively monitor patients and help guide clinical decision making, specifically with regards to subsets of patients to consider HCV therapy.”

Disclosure: See the study for a full list of relevant financial disclosures.