Nearly one quarter of people who are coinfected with HIV and hepatitis C virus (HCV) may experience rapid liver damage, say researchers of a study published in the October 2007 issue of AIDS.

In the study, Mark Sulkowski, MD, of the Johns Hopkins School of Medicine in Baltimore, and his colleagues enrolled 174 people infected with both viruses. The majority of the participants were African-American men, and most were being treated for HIV. Liver biopsies were taken at study entry and three years later.

Dr. Sulkowski’s group found that 24 percent of the participants in the study had significant worsening of liver damage between the first and second biopsies, which is twice as many as would be expected in HIV-negative people with hepatitis C. This was true even in those whose first biopsy found only mild liver damage. The researchers also reported that successful HIV treatment had no effect on the rate of HCV disease progression. Treatment for HCV, except in those who maintained undetectable HCV viral loads—a sustained virologic response—also appeared to have no protective effect.

Current standard of care for tracking HCV disease progression is to take liver biopsies every three years, as the disease tends to progress slowly in people infected only with HCV. There is also disagreement among experts as to when treatment for HCV should be started. Some recommend aggressive early treatment no matter a person’s current degree of liver damage, while others recommend delaying treatment until a biopsy indicates disease progression. Dr. Sulkowski’s group did not make any recommendations of its own but called for additional research to explore the timing of biopsies and treatment in coinfected patients. 

An elevated blood level of aspartate aminotransferase (AST), a liver enzyme, at the time of the first biopsy did partially predict those patients who went on to have HCV disease progression.