Evaluation of APRI score in liver disease following the introduction of antiretroviral therapy in HIV and HCV coinfected versus HIV monoinfected patients

• Published in: Revista da Sociedade Brasileira de Medicina Tropical Vol. 43; no. 6; pp. 678 - 681
• Main Authors: Antonello, Vicente Sperb, Tovo, Cristiane Valle, Kliemann, Dimas Alexandre, Santos, Breno Riegel, Zaltron, Vanice Ferrazza
• Format: Journal Article
• Language: Portuguese
• Published: Brazil Sociedade Brasileira de Medicina Tropical 01-11-2010
• Subjects: Adult; Alanine Transaminase - blood; Antiretroviral agents; Antiretroviral Therapy, Highly Active; Aspartate Aminotransferases - blood; CD4 Lymphocyte Count; Disease Progression; Female; Hepatitis C - complications; Hepatitis C - pathology; Hepatotoxicity; HIV Infections - complications; HIV Infections - drug therapy; Humans; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; Male; Prospective Studies; Sexually transmitted diseases; STD; Time Factors
• ISSN: 0037-8682; 1678-9849
• DOI: 10.1590/S0037-86822010000600015

The impact of highly active antiretroviral therapy (HAART) on hepatic fibrosis progression in HIV and hepatitis C virus coinfected patients is not completely understood. Noninvasive hepatic fibrosis markers show great promise in determining liver fibrosis staging and monitoring disease progression.
Twenty-four patients divided equally into two groups: 12 HIV-monoinfected and 12 with HIV/HCV coinfected patients, were followed from July 2008 to August 2009, after initiating HAART, with clinical, epidemiological and laboratorial assessments every 3 months and calculation of the aspartate aminotransferase to platelet ratio index (APRI). This study aimed to compare the progression of APRI, a noninvasive hepatic fibrosis marker, among populations with HIV and HIV/HCV coinfection.
No differences were observed between the groups regarding age, sex, measurement of CD4 and HIV viral load in all consultations, type of HAART and APRI before initiating HAART. Coinfected patients showed a significantly higher APRI than the monoinfected group in month 3 (0.57 ± 0.31 x 0.27 ± 0.105, p = 0.02) and 6 (0.93 ± 0.79 x 0.28 ± 0.11, p = 0.04).
In the present study, HAART was associated with APRI increases over six months follow-up in HIV/HCV coinfected patients, suggesting that these may be experiencing cumulative hepatotoxicity and immune reconstitution inflammatory syndrome after initiating antiretroviral drugs.