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Differences in liver fibrosis and response to pegylated interferon plus ribavirin in HIV/HCV‐coinfected patients with normal vs elevated liver enzymes
Author(s) -
Maida I.,
MartinCarbonero L.,
Sotgiu G.,
Vispo E.,
Barreiro P.,
GonzalezLahoz J.,
Soriano V.
Publication year - 2010
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/j.1365-2893.2009.01260.x
Subject(s) - ribavirin , medicine , pegylated interferon , gastroenterology , fibrosis , alanine aminotransferase , hepatitis c , cirrhosis , hepatitis c virus , immunology , virus
Summary. Severity of liver fibrosis and response to pegylated interferon plus ribavirin (pegIFN–RBV) are not well known in HIV/HCV‐coinfected patients with persistently normal alanine aminotransferase (PNALT). All HIV/HCV‐coinfected patients who had been assessed for liver fibrosis using elastometry during 2005 at our clinic were evaluated. Those with at least 1 year with three prior consecutive ALT measurements below the upper limit of normality were compared with patients with elevated ALT. Response to pegIFN–RBV was assessed in a subset of these patients. We analysed 87 patients with PNALT and 122 with elevated ALT. Compared to patients with elevated ALT, those with PNALT were significantly more often women (42% vs 26%), had greater mean CD4 counts (565 vs 420 cells/mm 3 ), had lower mean serum HCV‐RNA (5.8 vs 6.2 log IU/ml) and were infected by HCV genotype 4 (33% vs 6%). Liver fibrosis was considered as severe (Metavir F3) in 10% of patients with PNALT, and another 4% had cirrhosis based on stiffness values. These numbers were 16% and 35% in patients with elevated ALT. Treatment with pegIFN–RBV was given to 22 and 45 patients with PNALT and elevated ALT, respectively. Sustained virological response was achieved in 50% and 29% of them. In the multivariate analysis, PNALT was independently associated with response (OR: 7.9; 95% CI: 1.4–45.2; P = 0.02). Nearly 15% of HIV/HCV‐coinfected patients with PNALT showed advanced liver fibrosis (Metavir F3‐F4 estimates by elastometry). In summary, response to pegIFN–RBV is higher in patients with PNALT than in those with elevated ALT. Therefore, treatment should not be denied in HIV/HCV‐coinfected patients with PNALT.