Department of Medicine, Emory University, Atlanta, Georgia, USA.
Department of Medicine, University of California San Francisco, San Francisco, California, USA.
J Infect Dis. 2023 May 29;227(11):1274-1281. doi: 10.1093/infdis/jiac315.
The trajectory of liver fibrosis is not well understood in the contemporary era of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) therapy.
We assessed the Enhanced Liver Fibrosis (ELF) score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) in 116 women with HIV/HCV coinfection over a 4-year period. Random-effects linear regression models examined the rate of fibrosis change 1-2 years before starting HCV treatment, within 1 year before starting (peri-HCV treatment), within 1 year after and 1-2 years post-HCV treatment in unadjusted and adjusted models including age, race, and changes from pretreatment of factors that might affect fibrosis (eg, alcohol, integrase strand inhibitor [INSTI] use, waist circumference, CD4 count).
INSTI use nearly doubled from pre- to peri-HCV treatment. In unadjusted analysis, there was a 3.3% rate of rise in ELF pre-HCV treatment, 2.2% and 3.6% rate of decline during the peri- and 1-year post-HCV treatment period, respectively, followed by a 0.3% rise. Similar findings were observed for APRI and FIB-4. There was little effect on the estimated fibrosis trajectories after adjustment.
The apparent lack of decline in biomarkers of liver fibrosis beyond 1 year after HCV cure suggests that continued monitoring of liver fibrosis and interventions to mitigate progression in people with HIV after HCV cure remains essential.
在人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）治疗的当代，肝纤维化的轨迹尚不清楚。
我们在 4 年内评估了 116 例 HIV/HCV 合并感染女性的增强型肝纤维化（ELF）评分、天冬氨酸转氨酶-血小板比值指数（APRI）和纤维化-4（FIB-4）。随机效应线性回归模型在开始 HCV 治疗前 1-2 年、开始 HCV 治疗前 1 年内、开始 HCV 治疗后 1 年内和 1-2 年内检查了纤维化变化的速度，调整模型包括年龄、种族以及可能影响纤维化的因素（如酒精、整合酶链转移抑制剂 [INSTI] 使用、腰围、CD4 计数）从预处理开始的变化。
在开始 HCV 治疗前至开始 HCV 治疗前，INSTI 的使用几乎翻了一番。在未调整的分析中，ELF 在 HCV 治疗前的上升率为 3.3%，在 HCV 治疗期间和治疗后 1 年的下降率分别为 2.2%和 3.6%，随后上升了 0.3%。APRI 和 FIB-4 也有类似的发现。调整后对估计的纤维化轨迹影响不大。
在 HCV 治愈后 1 年以上，生物标志物肝纤维化的下降幅度不大，这表明在 HCV 治愈后，仍需继续监测 HIV 患者的肝纤维化，并采取干预措施减轻其进展。
