Didanosine (ddI) associates with increased liver fibrosis in adult HIV-HCV coinfected patients

• Published in: Journal of viral hepatitis Vol. 19; no. 10; pp. 685 - 693
• Main Authors: Suárez-Zarracina, T., Valle-Garay, E., Collazos, J., Montes, A. H., Cárcaba, V., Carton, J. A., Asensi, V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2012
• Subjects: Adult; Age; Age Factors; Anti-HIV Agents - administration & dosage; antiretrovirals; Antiviral agents; CD4 antigen; Didanosine; Didanosine - administration & dosage; Enzyme-Linked Immunosorbent Assay; Ethanol; Female; Fibrosis; Gelatinase A; Geriatrics; Hepatitis B; Hepatitis C virus; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - epidemiology; highly active antiretroviral therapy; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infection; Lipodystrophy; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver diseases; liver fibrosis; Lymphocytes T; Male; matrix metalloproteases; Matrix metalloproteinase; Matrix Metalloproteinases - blood; Microarray Analysis; Middle Aged; Proteinase inhibitors; Risk Factors; Serum levels; Sex Factors; Tissue inhibitor of metalloproteinase 2; Tissue Inhibitor of Metalloproteinases - blood; transition elastometry; Viral Load
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/j.1365-2893.2012.01596.x

The role of exposure to antiretrovirals (ARV) and serum matrix metalloproteases (MMPs) on liver fibrosis (LF) progression in human immunodeficiency virus (HIV) mono or HIV– hepatitis C virus (HCV) coinfection is unclear. Thus, 213 Caucasian adult HIV‐infected patients were studied, 111 of whom had HCV‐coinfection and 68 were HCV‐monoinfected. Patients with ethanol consumption >50 g/day, hepatitis B coinfection, non‐infective liver diseases or HAART adherence <75% were excluded. LF was assessed by transient elastometry (TE, Fibroscan). Serum levels of MMPs (MMP ‐1,‐2,‐3,‐8,‐9,‐10 and ‐13) and their tissue inhibitors (TIMP‐1,‐2 and ‐4) were measured by ELISA microarrays. Associations with LF were statistically analysed. Protease inhibitors, usually administered to patients with advanced LF were excluded from the analysis. Increased LF was significantly associated with d4T (P = 0.006) and didanosine (ddI) use (P = 0.007), months on d4T (P = 0.001) and on ARV (P = 0.025), duration of HIV (P < 0.0001) and HCV infections (P < 0.0001), higher HIV (P = 0.03) and HCV loads (P < 0.0001), presence of lipodystrophy (P = 0.02), male gender (P = 0.02), older age (P = 0.04), low nadir (P = 0.02) and current CD4+ T‐cells (P < 0.0001), low gain of CD4+ T‐cells after HAART (P = 0.01) and higher MMP‐2 (P = 0.02) and TIMP‐2 serum levels (P = 0.02). By logistic regression the only variables significantly associated with increased LF were: use of ddI (OR 8.77, 95% CI: 2.36–32.26; P = 0.005), male gender (OR 7.75, 95% CI: 2.33–25.64, P = 0.0008), HCV viral load (in log) (OR 3.53, 95% CI: 2.16–5.77; P < 0.0001) and age (in years) (OR 1.21, 95% CI: 1.09–1.34, P = 0.0003). We conclude that only higher HCV viral load, older age, male gender, and use of ddI associated independently with increased LF in our study.