Journal Article

Rapid Progression to Decompensated Cirrhosis, Liver Transplant, and Death in HIV-infected Men After Primary Hepatitis C Virus Infection

Fierer, Joshua, Branch, Andrea D., Dieterich, Douglas T., Marks, Kristen M., Smith, Davey M., Fierer, Daniel S., Fusco, Dahlene N., Hsu, Ricky, Fiel, M. Isabel

2013

Overview

Background. We and others have shown that primary hepatitis C (HCV) infection in men infected with human immunodeficiency virus (HIV) causes early-onset liver fibrosis; however, little is known about the long-term natural history of the liver disease in these HIV-infected men. Methods. We followed a cohort of HIV-infected men with primary HCV infection in New York City. Results. Four men who were not cured after their primary HCV infection developed decompensated cirrhosis within 17 months to 6 years after primary HCV infection. Three died within 8 years of primary HCV infection, and 1 survived after liver transplant done 2 years after primary HCV infection. Three of the 4 men had AIDS at the time of primary HCV infection, and the most rapid progression occurred in the 2 men with the lowest CD4 counts at the time of HCV infection. Liver histopathology was most consistent with HCV-induced damage even though some had exposures to other potential hepatotoxins. Conclusions. Primary HCV infection resulted in decompensated cirrhosis and death within 2–8 years in 4 HIV-infected men. The rapid onset of fibrosis due to primary HCV infection in HIV-infected men cannot therefore be considered benign. The rate of continued progression to liver failure may be proportional to the degree of underlying immunocompromise caused by HIV infection. More research is needed to better define the mechanisms behind accelerated liver damage.

• Publisher: Oxford University Press
• Subject: Adult / AIDS / Biological and medical sciences / Biopsies / CD4 Lymphocyte Count / Cirrhosis / Cohort Studies / Fatal Outcome / Fibrosis / Gastroenterology. Liver. Pancreas. Abdomen / Hepacivirus / Hepatitis / Hepatitis C / Hepatitis C - complications / Hepatitis C - therapy / Histocytochemistry / Histopathology / HIV / HIV Infections - complications / HIV Infections - immunology / HIV/AIDS / Human immunodeficiency virus / Human viral diseases / Humans / Infections / Infectious diseases / Liver / Liver - pathology / Liver cirrhosis / Liver Cirrhosis - complications / Liver Cirrhosis - diagnosis / Liver diseases / Liver failure / Liver Failure - complications / Liver Failure - diagnosis / Liver Transplantation / Liver. Biliary tract. Portal circulation. Exocrine pancreas / Male / Medical sciences / Mens health / Middle Aged / New York City / Other diseases. Semiology / Survival analysis / Time Factors / Transplants & implants / Viral diseases / Viral diseases of the lymphoid tissue and the blood. Aids / Viral hepatitis