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More Improvement than Progression of Liver Fibrosis Following Antiretroviral Therapy in A Longitudinal Cohort of HIV-infected Patients With or Without HBV and HCV Co-infections.

More Improvement than Progression of Liver Fibrosis Following Antiretroviral Therapy in A Longitudinal Cohort of HIV-infected Patients With or Without HBV and HCV Co-infections.
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Ding Y, Duan S, Ye R, Yang Y, Yao S, Wang J, Cao D, Liu X, Lu L, Jia M, Wu Z, He N,


Ding Y, Duan S, Ye R, Yang Y, Yao S, Wang J, Cao D, Liu X, Lu L, Jia M, Wu Z, He N, (click to view)

Ding Y, Duan S, Ye R, Yang Y, Yao S, Wang J, Cao D, Liu X, Lu L, Jia M, Wu Z, He N,

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Journal of viral hepatitis 2016 12 07() doi 10.1111/jvh.12658

Abstract

We examined the effect of combination antiretroviral therapy (cART) on liver fibrosis among HIV-infected patients with or without Hepatitis B (HBV) or C virus (HCV) co-infection. This was a retrospective cohort study of HIV-infected patients receiving cART during 2004-2016. Liver fibrosis was assessed using Fibrosis-4 (FIB-4) score with 3 classifications: Class 1, < 1.45; Class 2, 1.45-3.25; Class 3, > 3.25. Of 3,900 participants, 68.6% were HIV mono-infected, 5.3% were HIV/HBV co-infected, 23.8% were HIV/HCV co-infected and 2.3% were HIV/HBV/HCV co-infected. Participants received follow-up treatment (median was 3.3 years). Improvement to a lower class was observed in Class 2 (52.6%) and Class 3 (74.2%), respectively. Progression to a higher class was observed in 12.8% and 5.0% in Class 1 and Class 2, respectively and with a median time of 5.7 months. For improvement to lower classes, older age, male, Dai ethnicity, injection drug use, HCV co-infection, and tenofovir for treatment were negative predictors, but in Class 3 of FIB-4 and time-updated increases in CD4 count from baseline was positive predictors. For progression to higher classes, older age, male, Jingpo ethnicity and HCV co-infection, were positive predictors, while baseline CD4 count and in Class 2 of FIB-4 were negative predictors. Improvement to lower class linked with decreased mortality risk among patients in Class 3. Early cART initiation for HIV-infected patients with and without hepatitis co-infections may mitigate or slow down some of liver fibrosis, but special attention should be given to those who are older, male, co-infected with HCV. This article is protected by copyright. All rights reserved.

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