THE NEW EPIDEMIC HIV/HCV CO-INFECTION Part 3
The researchers conclude that the immune compromise caused by HIV may promote the selection of new HCV viral species, and this could contribute to persistent infection and progression of liver disease in coinfected people.10
Other researchers have found that HIV/HCV coinfection is increasing at an alarming rate and is leading to earlier, often fatal, liver damage. Because coinfection with HIV is associated with more potent viremia, it may accelerate the progression to liver damage in HCV5:
HCV levels are significantly higher in coinfected individuals than in those with HCV alone.22
Coinfected individuals have a significantly higher incidence of genotype 1 than do those infected with HCV alone.12
Alcohol abuse or heavy drinking is a widely recognized cofactor in progression to liver disease and is an undisputed risk factor in fibrosis. Other predictors of progression to cirrhosis are age and immune status (CD4+ count) at time of HCV infection.13
Since the goal of treating HCV is to avoid liver disease, it is important to obtain liver biopsies to accurately assess baseline liver disease and to select treatments based on that.3,5
According to McGovern, who conducted a study with her colleagues at the Lemuel Shattuck Hospital in Jamaica Plain, Massachusetts, End-stage liver disease due to underlying HCV/HBV [infection] is now the leading cause of death in patients with underlying HIV at our institution…Patients with co-infection with HCV and/or HBV need careful assessment of the possibility of underlying liver disease prior to initiation of antiretroviral therapy.14
McGovern’s study of coinfected patients found high and increasing risks of liver damage and end stage liver disease.
In this study, many patients taking HAART therapy lowered their viral loads to undetectable or low levels and raised their CD4 counts to greater than 200 cells per microliter. Yet an increasing number of these coinfected patients died from liver complications. Many had accelerated progression to liver cirrhosis (scarring) and end-stage liver disease.
McGovern found that over half of the patients who died in the Massachusetts study had an undetectable HIV RNA viral load, with CD4 counts greater than 200 cells per microliter, within one year prior to death. Also, one out of three in the study group had to discontinue HAART due to liver toxicity.14
In another recent hospital study in Pennsylvania, Gupta found an alarming rise in the rate of coinfection between 1996 and 1998-from under 10% to over 50%.15
A frequent concern today is whether highly active antiretroviral therapy (HAART) leads to liver damage in coinfected people. Selik, who has also examined trends connecting HAART treatment and liver disease in coinfected patients, confirms the association between HAART and liver disease, but emphasizes that no report has yet proved a cause-and- effect relationship. A number of factors could explain the trend of increased deaths due to liver disease in HIV patients16