Fibrosis progression in paired liver biopsies from HIV/HCV co-infected patients

Background: chronic hepatitis c is more aggressive during hiv infection. available data about risk factors of liver fibrosis in hiv/hcv co-infected patients derive from studies based on a single liver biopsy.objectives: to evaluate the risk factors of liver fibrosis progression (lfp) and to investigate the role of antiretroviral therapy (arv) in hiv/hcv patients who underwent paired liver biopsy.patients and methods: we retrospectively studied 58 patients followed at two infectious diseases departments in northern italy during the period 1988-2005. all specimens were double-blinded and centrally examined by two pathologists. lfp was defined when an increase of at least one stage occurred in the second biopsy, according to the ishak-knodell classification.results: in a univariate analysis, serum levels of alanine aminotransferase (alt) > 150 iu/l at the first biopsy (p = 0.02), and a > 20% decrease in cd4+ cell count between the two biopsies (p = 0.007), were significantly associated with lfp. in multivariate analysis, a > 20% decrease in cd4+ cell count remained independently associated to lfp (odds ratio, 3.99; 95% confidence interval, 1.25-12.76; p < 0.02). analysis of life survival curves confirmed the correlation between cd4+ cell count and lfp.conclusions: our findings highlight that in hiv/hcv coinfected patients, an effective antiretroviral therapy that assures a good immune-virological profile contributes to reducing the risk of lfp.