https://orcid.org/0000-0001-7842-512X
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Annelys Roque Gardner, Yifei Ma, Peter Bacchetti, Jennifer C Price, Mark H Kuniholm, Audrey L French, Stephen Gange, Adaora A Adimora, Howard Minkoff, Seble Kassaye, Igho Ofotokun, William Rosenberg, Andrea A Z Kovacs, Phyllis C Tien, Longitudinal Assessment of the Enhanced Liver Fibrosis Score in the Era of Contemporary HIV and Hepatitis C Virus Treatment, The Journal of Infectious Diseases, Volume 227, Issue 11, 1 June 2023, Pages 1274–1281, https://doi.org/10.1093/infdis/jiac315
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Abstract
The trajectory of liver fibrosis is not well understood in the contemporary era of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) therapy.
We assessed the Enhanced Liver Fibrosis (ELF) score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) in 116 women with HIV/HCV coinfection over a 4-year period. Random-effects linear regression models examined the rate of fibrosis change 1–2 years before starting HCV treatment, within 1 year before starting (peri-HCV treatment), within 1 year after and 1–2 years post-HCV treatment in unadjusted and adjusted models including age, race, and changes from pretreatment of factors that might affect fibrosis (eg, alcohol, integrase strand inhibitor [INSTI] use, waist circumference, CD4 count).
INSTI use nearly doubled from pre- to peri-HCV treatment. In unadjusted analysis, there was a 3.3% rate of rise in ELF pre-HCV treatment, 2.2% and 3.6% rate of decline during the peri- and 1-year post-HCV treatment period, respectively, followed by a 0.3% rise. Similar findings were observed for APRI and FIB-4. There was little effect on the estimated fibrosis trajectories after adjustment.
The apparent lack of decline in biomarkers of liver fibrosis beyond 1 year after HCV cure suggests that continued monitoring of liver fibrosis and interventions to mitigate progression in people with HIV after HCV cure remains essential.
