Jennifer Audsley and Philipp du Cros contributed equally to this work.
HIV replication is associated with increased severity of liver biopsy changes in HIV-HBV and HIV-HCV co-infection†
Version of Record online: 14 MAY 2012
Copyright © 2012 Wiley Periodicals, Inc.
Journal of Medical Virology
Volume 84, Issue 7, pages 993–1001, July 2012
How to Cite
Audsley, J., du Cros, P., Goodman, Z., McLean, C., Mijch, A., Lewin, S. R. and Sasadeusz, J. (2012), HIV replication is associated with increased severity of liver biopsy changes in HIV-HBV and HIV-HCV co-infection. J. Med. Virol., 84: 993–1001. doi: 10.1002/jmv.23236
- Issue online: 14 MAY 2012
- Version of Record online: 14 MAY 2012
- Manuscript Accepted: 22 DEC 2011
- NHMRC Centre for Clinical Research Excellence in Infectious Diseases
- University of Melbourne
- National Institute of Health. Grant Number: RO1 A1060449
- Alfred Foundation
- HIV-hepatitis co-infection;
- liver biopsy;
- HIV RNA;
- liver fibrosis
Histological parameters were assessed in liver biopsies (n = 48) performed in patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in order to evaluate factors which were associated with significant liver disease. Necroinflammation and fibrosis was scored by the Ishak classification system, and binary logistic regression analysis was used to assess HIV and antiretroviral-related determinants of necroinflammation and fibrosis. A total of 46 biopsies were included; 33 were from HIV-positive patients co-infected with HCV and 15 biopsies were from HIV-positive patients co-infected with HBV. One HIV-positive patient was co-infected with HBV and HCV. Median biopsy inflammatory grade for the cohort was 8.5 (IQR 6–10), the median fibrosis Stage 2 (IQR 1.8–4), and the median steatosis score was 1 (IQR 0–2). At the univariate level, HIV-related variables that were significantly associated with more severe biopsy changes were higher HIV RNA at the time of biopsy (associated with inflammatory Grade 10+; P = 0.018) and any exposure to didanasine (ddI) or stavudine (D4T; associated with fibrosis Stage 3+; P = 0.022). HIV RNA at the time of biopsy remained significant at the multivariate level. Patients with HIV hepatitis co-infection in this cohort had surprisingly mild changes in liver histology, and there were no statistically significant differences between biopsy results in HBV compared to HCV co-infection. The association between HIV RNA and necroinflammation supports current recommendations for earlier initiation of HAART in patients with HIV-hepatitis co-infection. J. Med. Virol. 84: 993–1001, 2012. © 2012 Wiley Periodicals, Inc.