updateonalcohol,otherdrugs,andhealth.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Studies on HIV and HCV * * Persons Coinfected with HIV and Hepatitis C have Liver Fibrosis Measures Equal to Those with Hepatitis C Only who are Nearly a Decade Older Kirk GD, et al. Ann Intern Med. 2013;158(9):658–666. Summary by Darius A. Rastegar, MD * * Objectives/Methods Persons with HIV infection manifest an increased risk for a variety of conditions at ages younger than those without HIV. Researchers analyzed data from a cohort of people with current and former injection drug use in Baltimore to investigate whether HIV reduces the age at which hepatitis C virus (HCV)-associated liver disease occurs. The study included 1176 participants who had positive antibodies for HCV and at least one valid liver fibrosis assessment by transient elastography. * Results Overall, 13.9% of participants had cirrhosis at baseline and 10.6% had clinically significant fibrosis. Liver fibrosis was associated with older age, HIV infection, black race, having ever using alcohol daily, chronic hepatitis B infection, greater body mass index, and higher HCV viral load level. In multivariable analysis, liver fibrosis remained significantly associated with all of these factors, except race. * * * * * Results (cont’d) Among those infected with HIV, lower CD4 counts and higher HIV viral loads were associated with liver fibrosis. Participants with HIV had liver fibrosis measurements equal to those without HIV who were, on average, 9.2 years older. * Comments This study indicates that people with current and former injection drug use who are coinfected with HIV and hepatitis C have a more rapid progression to fibrosis. Another novel finding was that HCV viral load level was also associated with fibrosis. Characteristics associated with fibrosis that can be addressed in patients include alcohol use, hepatitis B prophylaxis, and excessive weight gain. * * * * Comments (cont’d) The association between a