Incidence and predictors of severe liver fibrosis in human immunodeficiency virus-infected patients with chronic hepatitis C: A European collaborative study

A study was performed in 10 European health care centers in which 914 patients coinfected with hepatitis C virus ( HCV) and human immunodeficiency virus ( HIV) who had elevated serum alanine aminotransferase ( ALT) levels underwent liver biopsy during the period of 1992 through 2002. Overall, the METAVIR liver fibrosis stage was F0 in 10% of patients, F1 in 33%, F2 in 22%, F3 in 22%, and F4 in 13%. Predictors of severe liver fibrosis ( METAVIR stage, F3 or F4) in multivariate analysis were age of 135 years ( odds ratio [ OR], 2.95; 95% confidence interval [ CI], 2.08 - 4.18), alcohol consumption of > 50 g/day ( OR, 1.61; 95% CI, 1.1 - 2.35), and CD4(+) T cell count of <500 cells/ mm(3) ( OR, 1.43; 95% CI, 1.03 - 1.98). Forty- six percent of patients aged >40 years had severe liver fibrosis, compared with 15% of subjects aged > 30 years. The use of antiretroviral therapy was not associated with the severity of liver fibrosis. In summary, severe liver fibrosis is frequently found in HCV- HIV - coinfected patients with elevated serum ALT levels, and its severity increases significantly with age. The rate of complications due to end- stage liver disease will inevitably increase in this population, for whom anti- HCV therapy should be considered a priority.