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HIV Load Tied to Fibrosis Signal in Women Without Hepatitis or Alcohol Abuse
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17th Conference on Retroviruses and Opportunistic Infections, February 16-19, 2010, San Francisco
Mark Mascolini
Higher HIV load correlated with a higher FIB-4 fibrosis index in HIV-infected nonalcoholic women without hepatitis virus infection or antiretroviral experience, according to results of a 1227-woman analysis of the HIV Epidemiologic Research Study (HERS) [1].
HERS is a natural history study of HIV infection in US women that ran from 1993 through 2000. This fibrosis analysis involved four groups of women--196 infected only with hepatitis C virus (HCV), 320 infected only with HIV, 498 infected with both viruses, and 213 with neither infection. The investigators also assessed another 72 women infected only with HIV who were negative for hepatitis B surface antigen and HCV, never took antiretrovirals, and reported no alcohol use in the past 6 months.
The study relied on the FIB-4 scale, a composite fibrosis indicator including age, alanine aminotransferase, aspartate aminotransferase, and platelet count. Earlier research determined that a FIB-4 below 1.45 generally means a person does not have advanced fibrosis, while a FIB-4 above 3.5 suggests advanced fibrosis [2].
In HERS women, median FIB-4 was lowest in those not infected with HIV or HCV (0.60), higher and similar in HCV-monoinfected women (0.83) and HIV-monoinfected women (0.86), and highest in HIV/HCV-coinfected women (1.30). The 72 antiretroviral-naive women with HIV but without HCV or HBV had a median FIB-4 of 0.93, similar to the larger HIV-monoinfected group. A small minority of women had a FIB-4 above the suggested fibrosis cutoff of 3.5, with the highest prevalence in coinfected women (8.6%), followed by HCV-monoinfected women (4.6%), and HIV-monoinfected women (1.3%).
Multivariate analysis determined that albumin and CD4 count had a significant negative association with FIB-4 score in HIV-monoinfected women and HIV/HCV-coinfected women, but not in HCV-monoinfected women or uninfected women.
HIV-monoinfected women
· Albumin: r = -0.188, P = 0.0007
· CD4 count: r = -0.401, P < 0.0001
HIV/HCV-coinfected women
· Albumin: r = -0.235, P < 0.0001
· CD4 count: r = -0.332, P < 0.0001
In univariate analyses, higher viral load correlated positively with higher FIB-4 score in HIV/HCV-coinfected women (r = 0.177, P < 0.001), HIV-monoinfected women (r = 0.207, P = 0.0002), and alcohol-abstaining, antiretroviral-naive, HIV-monoinfected women without HBV or HCV (r = 0.202, P = 0.03).
Although the viral load associations with FIB-4 score did not hold up in multivariate analysis, the investigators propose that the correlations suggest "a potential relationship between HIV and hepatic fibrosis in vivo." That suggestion is especially compelling in the monoinfected women with no antiretroviral experience, no exposure to HBV or HCV, and no recent alcohol use. Although higher viral load may not independently correlate with higher FIB-4 in those women, the viral load risk is not confounded by alcohol, hepatitis, or antiretroviral hepatotoxicity.
References
1. Blackard J, Welge J, Taylor L, et al. HIV mono-infection is associated with a non-invasive index of liver fibrosis in women. 17th Conference on Retroviruses and Opportunistic Infections. February 16-19, 2010. San Francisco. Abstract 681.
2. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317-1325.
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