Non-invasive assessment of liver fibrosis in HIV infected adults with and without HCV / HBV co-infection and exposure to dideoxynucleosides

Aims: Liver disease is a common complication in individuals with HIV infection. Recently, exposure to antiretroviral agents such as dideoxynucleosides (i.e. stavudine, didanosine, and zalcitabine) has been recognized as a potential cause of liver injury which over time may lead to significant liver fibrosis. Transient elastography allows for non-invasive assessment of liver fibrosis and may be helpful to characterize dideoxynucleoside-related hepatic side effects. Methods: Transient elastography (FibroScan, Echosens, France) was performed in 190 consecutive individuals (151 men, mean age 47±9 years) with HIV mono-infection (n=133) or co-infection with HCV and / or HBV (n=57). Significant liver fibrosis and cirrhosis were considered to be present if liver stiffness values were ≥7.65 kPa, and ≥13,01 kPa, respectively (corresponding to METAVIR score F ≥2, and F4). Individuals were well-characterized with regard to exposure to antiretroviral therapy, particularly dideoxynucleosides. Results: Significant fibrosis and cirrhosis was present in 4.5% and 0.8% of HIV mono-infected individuals and in 33% and 14% of co- infected individuals, respectively. Overall, individuals with exposure to dideoxynucleosides (n=81) had higher mean liver stiffness values as compared to those without exposure (p=0.03) and were more likely to have significant fibrosis (p<0.05, one-sided). Highest liver stiffness values were observed in HCV co-infected individuals with exposure to dideoxynucleosides (10.2±8.6 kPa). Liver stiffness values in HIV mono-infected individuals were generally low, irrespective of dideoxynucleosides exposure. Discussion: Exposure to dideoxynucleosides in individuals with HIV infection is associated with higher liver stiffness values as measured by transient elastography. These data suggest that dideoxynucleosides may contribute to significant liver fibrosis, particularly in individuals who are co-infected with HCV.

HAART - HCV - HIV coinfection - liver fibrosis - transient elastograpy