Longitudinal Assessment of the Enhanced Liver Fibrosis Score in the Era of Contemporary HIV and Hepatitis C Virus Treatment

• Published in: The Journal of infectious diseases Vol. 227; no. 11; pp. 1274 - 1281
• Main Authors: Gardner, Annelys Roque, Ma, Yifei, Bacchetti, Peter, Price, Jennifer C, Kuniholm, Mark H, French, Audrey L, Gange, Stephen, Adimora, Adaora A, Minkoff, Howard, Kassaye, Seble, Ofotokun, Igho, Rosenberg, William, Kovacs, Andrea A Z, Tien, Phyllis C
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 29.05.2023
• Subjects: Antiviral drugs; Aspartate transaminase; CD4 antigen; Female; Fibrosis; Hepacivirus; Hepatitis C; Hepatitis C - complications; Hepatitis C - drug therapy; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Integrase; Liver; Liver Cirrhosis; Major; Regression analysis; Transaminase; Viruses; enhanced liver fibrosis score; HIV; hepatitis C; APRI; FIB-4; ELF; direct-acting antiviral therapy
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiac315

Abstract Background The trajectory of liver fibrosis is not well understood in the contemporary era of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) therapy. Methods We assessed the Enhanced Liver Fibrosis (ELF) score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) in 116 women with HIV/HCV coinfection over a 4-year period. Random-effects linear regression models examined the rate of fibrosis change 1–2 years before starting HCV treatment, within 1 year before starting (peri-HCV treatment), within 1 year after and 1–2 years post-HCV treatment in unadjusted and adjusted models including age, race, and changes from pretreatment of factors that might affect fibrosis (eg, alcohol, integrase strand inhibitor [INSTI] use, waist circumference, CD4 count). Results INSTI use nearly doubled from pre- to peri-HCV treatment. In unadjusted analysis, there was a 3.3% rate of rise in ELF pre-HCV treatment, 2.2% and 3.6% rate of decline during the peri- and 1-year post-HCV treatment period, respectively, followed by a 0.3% rise. Similar findings were observed for APRI and FIB-4. There was little effect on the estimated fibrosis trajectories after adjustment. Conclusions The apparent lack of decline in biomarkers of liver fibrosis beyond 1 year after HCV cure suggests that continued monitoring of liver fibrosis and interventions to mitigate progression in people with HIV after HCV cure remains essential. Using serial measurements of ELF, APRI, and FIB-4 over a 4-year period in women with HIV/HCV coinfection, we observed a rise in serum biomarkers of liver fibrosis followed by declines that began within the year before starting HCV treatment.