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About 15 to 30 percent of HIV-infected individuals in the United States are coinfected with hepatitis C virus (HCV), which causes liver disease. Advanced antiretroviral therapy (ART) has been linked to significant liver enzyme elevations, (indicative of liver toxicity) in 5 to 10 percent of HIV-infected people taking ART. Nevertheless, despite widespread use of ART and documented instances of ART-related hepatitis, a recent study found no evidence that ART caused serious liver disease among HIV patients coinfected with HCV. The study was supported in part by the Agency for Healthcare Research and Quality (HS07809).
Researchers at the Johns Hopkins Schools of Public Health and Medicine estimated the burden of liver disease among HIV/HCV-coinfected individuals receiving ART and evaluated whether liver disease was associated with factors they could identify, such as ART-related liver enzyme elevations (LEEs). The study group comprised 210 HIV/HCV coinfected patients undergoing care in the Johns Hopkins University HIV clinic. Sixty-four percent of those studied had received ART within 2 years of liver disease assessment, 33 percent had no fibrosis (scarring of the liver), and 26 percent had bridging fibrosis (more extensive scarring) or cirrhosis (severe scarring that impairs liver function).
ART was not associated with fibrosis. However, there was significantly less liver inflammation among patients who had received ART longer and more effectively (greater suppression of HIV RNA). Twelve percent of individuals had previous ART-associated LEEs, but liver fibrosis was not more severe if the LEE resolved. On the other hand, liver fibrosis was more severe in those who had persistent LEEs. The study findings suggest that ART-associated LEE does not increase the risk of advanced fibrosis, and that the increased risk of LEE among HCV-coinfected patients should not make physicians reluctant to prescribe ART.
See "The effect of antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection," by Shruti H. Mehta, M.P.H., David L. Thomas, M.D., Michael Torbenson, M.D., and others, in the January 2005 Hepatology 41, pp. 123-131.
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