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Human Immunodeficiency Virus Worsens Hepatitis C Outlook For Drug Injectors

Interferon therapy has a protective effect against cirrhosis related to human immunodeficiency virus no matter what the patient's HIV status is.

This is one finding of a long-term retrospective cohort study of the influence of human immunodeficiency virus (HIV) co-infection on chronic hepatitis C in injection drug users.

Human immunodeficiency virus (HIV) coinfection was also found in this study to worsen the outcome of chronic hepatitis C, increasing both serum hepatitis C virus (HCV)-RNA level and liver damage and decreasing sustained response to interferon therapy.

Age and alcohol were found to be cofactors linked with cirrhosis and mortality.

Researchers also considered the impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy and liver-related death. Age, alcohol consumption, immune status and HCV-related virologic factors were included.

Study participants were 80 HIV-positive and 80 HIV-negative injection drug users enrolled between 1980 and 1995 and matched by age, gender, and duration of HCV infection. Participants were followed up over 52 months, and primary outcome measure was progression to cirrhosis.

In HIV-positive patients, chronic hepatitis C was characterised by higher serum HCV-RNA levels, higher total Knodell score, and poorer sustained response to interferon therapy. High serum HCV-RNA level was linked with low CD4-lymphocyte count.

Whereas increased fibrosis was related to decreased CD4-lymphocyte count, necroinflammatory score was higher in HIV-positive patients independently of the CD4-lymphocyte count.

In HIV-positive patients with low CD4 cell count and in interferon-untreated patients, progression to cirrhosis was accelerated independently of age at HCV infection.

Cirrhosis caused death in five HIV-positive patients.

Risk of death related to cirrhosis was increased in heavy drinkers and in HIV-positive patients with CD4 cell count less than 200/mm³.

Vincent Di Martino and colleagues from the Service d'Hepatologie, INSERM U481 et Centre de Recherche Claude Bernard sur les Hepatites Virales, Hopital Beaujon, Clichy, France did this analysis on the influence of HIV infection on chronic hepatitis C via multivariate analysis.
HEPATOLOGY 2001;34:1193-1199. "The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: A long-term retrospective cohort study (*Human Study*)"

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