Approximately 10% of HIV-positive patients who are not coinfected with hepatitis B or hepatitis C virus have liver stiffness – a reliable indicator of liver damage, according to a Spanish study presented to the Fourth International Workshop on HIV and Hepatitis Coinfection in Madrid. Factors associated with liver stiffness were a low CD4 cell count, heavy alcohol consumption, and antiretroviral therapy that included ddI (didanosine, Videx) or abacavir (Ziagen, also in the combination pills Trizivir and Kivexa).
It is well known that coinfection with HIV and hepatitis B virus or hepatitis C virus (or both) can cause serious damage to the liver. Indeed, liver disease caused by these two infections is now one of the leading causes of death in patients with HIV. There is also some evidence that treatment with particular anti-HIV drugs can damage the liver.
In the past few years FibroScan, a non-invasive test to monitor liver stiffness, has become a standard tool in the follow-up of patients coinfected with HIV and viral hepatitis. As it is painless, quick to perform and acceptable to patients, some HIV treatment centres have been extending its use to include the monitoring of liver health in patients without viral hepatitis.
Spanish investigators performed liver stiffness Fibroscan tests on 269 HIV-positive patients. All these patients were known to be uninfected with either hepatitis B or hepatitis C virus.
A FibroScan result showing a liver stiffness of 7.2 kilopascals (kPa) was considered abnormal (an internationally accepted benchmark). Information was obtained via notes and questionnaires about possible risk factors for liver damage, such as alcohol consumption, immunological markers, and the use of antiretroviral drugs.
In “multivariate” analysis, the investigators found that daily alcohol consumption of 5g or more a day was associated with liver stiffness (adjusted odds ratio [AOR] 5.87; 95% confidence interval [CI], 2.28 – 14.63).
The investigators also found that patients with a CD4 cell count low enough to involve a risk of an AIDS-defining illness (200 cells/mm3) were also significantly more likely to have liver stiffness (AOR, 4.56; 95% CI, 1.60 – 12.95).
In the investigators’ first set of analyses, antiretroviral therapy with ddI (p = 0.01), d4T (stavudine, Zerit) (p = 0.006), abacavir (p = 0.001), and lopinavir (p = 0.02) were associated with liver stiffness. But in the subsequent multivariate analysis this association only remained for abacavir (AOR, 3.76; 95% CI, 1.48 – 9.52) and the association with ddI was of borderline significance (p = 0.07).
“Abnormal liver stiffness is present in a non-negligible proportion of HIV-infected patients without hepatitis B virus or hepatitis C virus coinfection”, conclude the investigators.
Merchante N. et al. Prevalence of abnormal liver stiffness assessed by transient hepatic elastometry in HIV-infected patients without HBV or HCV coinfection. Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 22, 2008.