Hepatitis Flares and Mortality in Patients with HIV and Hepatitis Virus Coinfection
Pretreatment inflammation and coagulation biomarkers are associated with increased risk for these important complications after initiation of antiretroviral therapy.
HIV infection accelerates the progression of liver disease in patients coinfected with hepatitis C virus (HCV) or hepatitis B virus (HBV). The risk for hepatitis flare after initiation of antiretroviral therapy (ART) is higher in coinfected patients than in HIV-monoinfected patients. In a recent retrospective cohort study, researchers examined a variety of pre-ART inflammation- and coagulation-related biomarkers to determine whether they might be predictive of hepatitis flare or mortality.
The study involved 287 HIV-infected patients (207 coinfected with HCV, 70 with HBV, and 10 with both HCV and HBV) who participated in a randomized trial of different ART regimens (FIRST). The main outcomes were hepatitis flare within 4 months — or death within 4 years — after ART initiation. Biomarker levels were measured using frozen plasma samples obtained prior to ART initiation.
Hepatitis flare occurred in 50 patients (17%) and was significantly more frequent in those with HBV (24%) or HBV/HCV (50%) than in those with HCV alone (14%). Hepatitis flare was associated with higher pretherapy alanine transaminase and interleukin (IL)-10 levels, as well as with higher plasma HBV DNA and HCV RNA levels. The 4-year mortality rate was 17%, and was not affected by hepatitis-flare status. In multivariable analyses, mortality was associated with higher levels of D-dimer, IL-6, IL-8, and soluble CD14 and detectable levels of hyaluronic acid. A composite score that included these biomarkers accurately categorized patients into groups that were at low, moderate, and high risk for death.
CITATION(S):
Andrade BB et al. Biomarkers of inflammation and coagulation are associated with mortality and hepatitis flares in persons coinfected with HIV and hepatitis viruses. J Infect Dis 2013 Feb 13; [e-pub ahead of print.].
