Progression of liver fibrosis following acute hepatitis C virus infection in HIV-positive MSM

Background: Whether continued, accelerated liver fibrosis progression occurs following acute hepatitis C virus infection (AHCVI) in HIV-positive MSM is unknown. Design and methods: HIV-positive MSM from the AIDS Therapy Evaluation in the Netherlands and MSM Observational Study for Acute Infection with Hepatitis C-cohorts with primary AHCVI and at least one fibrosis-4 (FIB-4) measurement less than 2 years before and 1 year after estimated AHCVI were included. Mixed-effect linear models were used to evaluate (time-updated) determinants of FIB-4 levels over time. Determinants of transitioning to and from FIB-4 1.45 and > 1.45 were examined using multistate Markov models. Results: Of 313 MSM, median FIB-4 measurements per individual was 12 (interquartile range ¼ 8–18) and median follow-up following AHCVI was 3.5 years (interquartile range¼ 1.9–5.6). FIB-4 measurements averaged at 1.00 [95% confidence interval (CI)¼ 0.95–1.05] before AHCVI, 1.31 (95% CI¼ 1.25–1.38) during the first year of AHCVI and 1.10(95% CI¼ 1.05–1.15)more than 1 year after AHCVI.Mean FIB-4more than 1 year after AHCVI was higher for chronically infected patients compared with those successfully treated (P¼ 0.007). Overall FIB-4 scores were significantly higher with older age, lower CD4þ cell count, longer duration from HIV-diagnosis or AHCVI, and nonresponse to HCVtreatment. At the end of follow-up, 60 (19.2%) and eight MSM (2.6%) had FIB-4 between 1.45–3.25 and 3.25, respectively. Older age, lower CD4þ cell count and detectable HIVRNA were significantly associated with higher rates of progression to FIB-4 > 1.45, whereas older age, longer duration from HIV-diagnosis and nonresponse to HCV-treatment were significantly associated with lower rates of regression to FIB-4 1.45. Conclusion: In this population of HIV-positive MSM, FIB-4 scores were higher during the first year of AHCVI, but FIB-4 3.25 was uncommon by the end of follow-up. Well controlled HIV-infection appears to attenuate FIB-4 progression.

• View at Publisher