Significant Liver Damage After Hepatitis C Microelimination Seen in Patients With HIV

Following microelimination of hepatitis C virus, patients HIV infection demonstrated a high burden of significant liver damage.

Persistent liver damage in patients with HIV infection is common following microelimination of hepatitis C virus (HCV) infection, according to study results published in the Journal of Infection.

Researchers conducted a study at the Hospital Universitario Virgen de Valme in Spain between 2019 and 2020 to analyze liver damage in patients with HIV infection. The liver health of 619 patients with HIV infection was assessed every 3 months using liver stiffness measurements and a controlled attenuation parameter. Significant liver damage was defined as a liver stiffness measurement of 7.2 kilopascals (kPa) or more at 2 assessments, and advanced liver damage was defined as liver stiffness of 14.0 kPa or more. Metabolic-associated fatty liver disease was defined as a controlled attenuation parameter of 248 decibal/milliwatts or more.

Among patients included in the final analysis, 83% were men, the median age was 52 years (IQR, 42-56) years, 96.4% were White, 56% were exposed to HIV through sexual contact, 89.2% had undetectable HIV viral loads, and 43% were positive for HCV antibodies. No patients with HCV antibodies had detectable plasma HCV RNA.

Liver damage was observed among 18.2% of patients and advanced liver damage was observed among 5.5% of patients. Most (78.8%) patients with significant liver damage were seropositive for HCV infection, among whom 8.9% had prior spontaneous viral clearance. Two patients with both HIV infection and advanced liver damage were positive for HCV antibodies and had active hepatitis B virus infection.

“Systematic screening for liver damage, by transient elastography, if available, is warranted in PLWH.”

Controlled attenuation parameter values consistent with metabolic-associated fatty liver disease were observed among 43.5% of patients. Additionally, high alcohol use disorder identification test consumption scores were observed among 2.9% of the patients, indicating a diagnosis of liver damage of mixed cause in 41.4%.

Overall, 35.7% of patients with significant liver damage had nonviral liver damage, representing 6.5% of the entire study population.

In the adjusted analysis, nonviral liver damage was significantly associated with high concentrations of gamma glutamyl transferase (adjusted odds ratio [aOR], 1.02; 95% CI, 1.01-1.04; P <.001), CD4+ cell counts (aOR, 1.0; 95% CI, 0.99-1; P =.03), and high-density lipoprotein cholesterol (aOR, 0.95; 95% CI, 0.92-0.98; P =.004).

Study limitations include the single-center design and the use of transient elastography to determine liver stiffness measurements and diagnosis significant liver damage.

“Systematic screening for liver damage, by transient elastography, if available, is warranted in PLWH [patients with HIV infection],” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.


Santos M, Corma-Gómez A, Fernandez-Fuertes M, et al. Burden of significant liver damage in people living with HIV after microelimination of the hepatitis C virus. J Infect. 2023;86(1):41-46. doi:10.1016/j.jinf.2022.11.004