1. Exposure to previous cART is associated with significant liver fibrosis and cirrhosis in human immunodeficiency virus-infected patients
- Author
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Raphael Mohr, Christoph Boesecke, Evrim Anadol, Jürgen K. Rockstroh, Carolynne Schwarze-Zander, Jonel Trebicka, Jan-Christian Wasmuth, and Kristina Lust
- Subjects
Liver Cirrhosis ,Male ,RNA viruses ,Cirrhosis ,lcsh:Medicine ,HIV Infections ,Hepacivirus ,medicine.disease_cause ,Pathology and Laboratory Medicine ,Gastroenterology ,0302 clinical medicine ,Immunodeficiency Viruses ,Fibrosis ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,lcsh:Science ,Didanosine ,Multidisciplinary ,Hepatitis C virus ,Liver Diseases ,Stavudine ,virus diseases ,HIV diagnosis and management ,Middle Aged ,Hepatitis C ,Vaccination and Immunization ,Infectious Diseases ,Medical Microbiology ,Viral Pathogens ,Viruses ,Liver Fibrosis ,030211 gastroenterology & hepatology ,Female ,Pathogens ,Viral hepatitis ,medicine.drug ,Research Article ,Adult ,medicine.medical_specialty ,Liver Cirrhosis/chemically induced ,Anti-HIV Agents ,Immunology ,Antiretroviral Therapy ,HIV Infections/complications ,Gastroenterology and Hepatology ,Microbiology ,03 medical and health sciences ,Antiviral Therapy ,Hepatitis C/complications ,Internal medicine ,Retroviruses ,medicine ,Humans ,Microbial Pathogens ,Flaviviruses ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Biology and Life Sciences ,HIV ,medicine.disease ,Hepatitis viruses ,Diagnostic medicine ,Cross-Sectional Studies ,Co-Infections ,Anti-HIV Agents/adverse effects ,lcsh:Q ,Liver function ,Preventive Medicine ,Transient elastography ,business ,Developmental Biology - Abstract
INTRODUCTION: Combined antiretroviral therapy (cART) has improved survival in HIV-patients. While the first antiretrovirals, which became available in particular D-drugs (especially didanosine and stavudine) and unboosted protease inhibitors, may impair liver function, the modern cART seems to decrease liver fibrosis. This study assessed the influence of exposure to previous antiretrovirals on liver fibrosis in HIV-infected patients.METHODS: This observational cross-sectional single-center study recruited 333 HIV patients and assessed liver fibrosis using transient elastography (TE).RESULTS: 83% were male with a median age of 45, while 131 were co-infected with viral hepatitis. Overall, 18% had significant fibrosis and 7.5% had cirrhosis. 11% of HIV mono-infected patients had significant fibrosis and 2% had cirrhosis. HCV infection (OR:5.3), history of exposure to didanosine (OR:2.7) and HIV load below 40copies/mL (OR:0.5) were independently associated with significant fibrosis, while HCV (OR:5.8), exposure to didanosine (OR:2.9) and azidothymidine (OR:2.8) were independently associated with cirrhosis. Interestingly, in HIV mono-infected patients, a HIV-load below 40copies/mL (OR:0.4) was independently associated with significant fibrosis, and didanosine (OR:20.8) with cirrhosis.CONCLUSION: In conclusion, history of exposure to didanosine and azidothymidine continues to have an impact on the presence of liver cirrhosis in HIV patients. However, HCV co-infection and ongoing HIV-replication have the strongest effect on development of significant fibrosis in these patients.
- Published
- 2018