Influence of Human Immunodeficiency Virus Infection on the Course of Hepatitis C Virus Infection: A Meta-Analysis [Graham CS et al. CID 2001;33:562]: The authors performed a meta-analysis to quantify the effect of HIV coinfection on progressive liver disease in persons who have HCV. Eight studies identified outcomes by histologic evidence of cirrhosis or decompensated liver disease. The pooled data showed that the relative risk of decompensated liver disease was 6.1 and the risk of cirrhosis was 2.1. The details of seven studies are summarized in the table below, which provides the individual data for adjusted RR:

Relative risk of liver disease with HIV-HCV co-infection
		Adjusted RR
Ref.	Pts.	Decompensated Liver Disease	Cirrhosis
12 JAIDS 1993;6:602	156	3.2
15 Brit J Haem 1994;87:555	183	21.4
13 Brit J Haem 1996;94:746	138	4.2	3.9
18 J. Hepatol 1997;26:1	547		1.9
16 J. Hepatol 1998;29:12	514		2.6
26 JID 1999;179:1254	134	7.4
23 Hepatology 1999;30:1054	244		1.5

Comment: The authors convincingly show that there is a significant risk of severe liver disease in persons with HIV-HCV, although there are limitations that prevent drawing conclusions regarding the influence of these data on management decisions. It is noted that about one half of the population reviewed were persons with hemophilia and, consequently, male, about half had genotype 1A or 1B, the influence of CD4 counts was not assessed, the possibly important role of alcohol consumption was not included, and the role of HAART in modifying these outcomes was not known. Despite these limitations, once again we find very solid evidence that HIV promotes progression of HCV liver disease; the influence of HCV on the progression of HIV remains controversial.
posted 8/28/2001

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