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Factors associated with liver fibrosis in intravenous drug users coinfected with HIV and HCV

Antiviral Therapy
International Medical Press
Publication Date
  • Biology
  • Medicine


©2011 International Medical Press 1359-6535 (print) 2040-2058 (online) 27 Antiviral Therapy 2011; 16:27–35 (doi: 10.3851/IMP1708) Background: Reliable non-invasive methods for the evaluation of liver fibrosis are desirable, and the risk factors associated with fibrosis are not fully identified. Methods: A cross-sectional study of a cohort of 805 HIV–HCV-coinfected patients with active HCV replication, most (95.2%) of whom were intravenous drug users, was conducted. Liver fibrosis was measured by transient elas- tometry with cutoff values of 7.2 kPa (significant fibro- sis), 9.4 kPa (advanced fibrosis) and 14.0 kPa (cirrhosis), and by liver fibrosis indexes (LFI; APRI, Forns and FIB-4). Available liver biopsies were also evaluated. Results: The prevalences of significant fibrosis, advanced fibrosis and cirrhosis were 55.8%, 38.4% and 23.5%, respectively. A number of parameters were associated both in the univariate and multivariate analyses with each of the diverse fibrosis groups; however, only six of them were predictive of all stages of fibrosis: heavy alco- hol intake (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.02–5.59; P<0.001), duration of HCV infection (OR 1.13, 95% CI 1.07–1.19; P<0.001), CDC category C3 (OR 1.80, 95% CI 1.07–3.02; P=0.026), anti-HCV treatment failure (OR 4.37, 95% CI 2.24–8.55; P<0.001), throm- bocytopaenia (OR 1.015, 95% CI 1.011–1.019; P<0.001) and increased aspartate aminotransferase (1.006, 95% CI 1.0021–1.010; P=0.004). Furthermore, 53%, 68% and 80% of patients with significant fibrosis, advanced fibro- sis and cirrhosis, respectively, had increased measures on at least one of the LFI, with the Forns index being the most sensitive. Area under the receiver operating charac- teristic curves of elastometry to predict histological fibro- sis was 0.83 (95% CI 0.76–0.90), 0.89 (95% CI 0.83–0.95) and 0.87 (95% CI 0.80–0.94) for Metavir score ≥F2, ≥F3 and F4, respectively. Conclusions: Elastometry constitutes a useful tool in the

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