Progression of liver fibrosis following acute hepatitis C virus infection in HIV-positive MSM

Astrid M. Newsum*, Katherine W. Kooij, Anders Boyd, Colette Smit, Ferdinand W. N. M. Wit, Jan T. M. van der Meer, Maria Prins, Peter Reiss, Marc van der Valk, H. van Eden, R. Molenkamp, F. Pijnappel, H. W. Reesink, J. Schinkel, G. S. Steba, G. E. L. van den Berk, K. Brinkman, Hooijenga, D. Kwa, N. van der MecheA. Toonen, A. van Kessel, M. van Duinen, M. T. E. Cornelissen, E. J. G. Peters, A. Verbon, J. E. A. van Beek, J. de Groot, M. G. J. de Boer, J. Smit, E. Smit, S. H. Lowe, A. M. L. Oude Lashof, D. Posthouwer, R. P. Ackens, K. Burgers, J. Schippers, I. H. M. van Loo, T. R. A. Havenith, P. H. M. Smits, S. Weijer, C. J. Brouwer, M. Knapen, M. de Haan, R. Jansen, M. Bakker, A. de Jong, M. van den Akker, R. van der Meer, M. Schutten, MOSAIC Study Group, ATHENA Observational HIV Cohort

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Whether continued, accelerated liver fibrosis progression occurs following acute hepatitis C virus infection (AHCVI) in HIV-positive MSM is unknown.

Design and methods: HIV-positive MSM from the AIDS Therapy Evaluation in the Netherlands and MSM Observational Study for Acute Infection with Hepatitis C-cohorts with primary AHCVI and at least one fibrosis-4 (FIB-4) measurement less than 2 years before and 1 year after estimated AHCVI were included. Mixed-effect linear models were used to evaluate (time-updated) determinants of FIB-4 levels over time. Determinants of transitioning to and from FIB-4 1.45 were examined using multistate Markov models.

Results: Of 313 MSM, median FIB-4 measurements per individual was 12 (interquartile range = 8-18) and median follow-up following AHCVI was 3.5 years (interquartile range = 1.9-5.6). FIB-4 measurements averaged at 1.00 [95% confidence interval (CI) = 0.95-1.05] before AHCVI, 1.31 (95% CI = 1.25-1.38) during the first year of AHCVI and 1.10 (95% CI = 1.05-1.15) more than 1 year after AHCVI. Mean FIB-4 more than 1 year after AHCVI was higher for chronically infected patients compared with those successfully treated (P = 0.007). Overall FIB-4 scores were significantly higher with older age, lower CD4(+) cell count, longer duration from HIV-diagnosis or AHCVI, and nonresponse to HCV-treatment. At the end of follow-up, 60 (19.2%) and eight MSM (2.6%) had FIB-4 between 1.45-3.25 and >= 3.25, respectively. Older age, lower CD4(+) cell count and detectable HIV-RNA were significantly associated with higher rates of progression to FIB-4 > 1.45, whereas older age, longer duration from HIV-diagnosis and nonresponse to HCV-treatment were significantly associated with lower rates of regression to FIB-4

Conclusion: In this population of HIV-positive MSM, FIB-4 scores were higher during the first year of AHCVI, but FIB-4 >= 3.25 was uncommon by the end of follow-up. Well controlled HIV-infection appears to attenuate FIB-4 progression. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.

Original languageEnglish
Pages (from-to)833-844
Number of pages12
Issue number5
Publication statusPublished - 1 Apr 2019


  • acute hepatitis C virus infection
  • fibrosis-4
  • HIV/hepatitis C virus coinfection
  • liver fibrosis
  • MSM
  • MEN
  • RISK
  • SEX

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