Important Risk Factors of Liver Cirrhosis in HIV and Hepatitis C Coinfected Patients: A Systematic Review

Hepatitis C virus (HCV) is the leading cause of chronic hepatitis and liver fibrosis. Due to shared modes of transmission with human immunodeficiency virus (HIV), HIV-HCV coinfection is also common worldwide. Multiple studies have shown that the rates of liver fibrosis and associated complications increase considerably in this sub-population compared to a single HCV infection. Thus, in this study, we aimed to conduct a systematic review of possible associated important risk factors of accelerated liver cirrhosis among HIV-HCV coinfected subjects.

A systematic review of published studies relevant to the main risk factors of liver cirrhosis progression in HIV and hepatitis C coinfected patients was performed using databases of PubMed, Web of Science, Scopus, and Embase were searched using keywords and their combinations. We retrieved all the relevant papers and reports published in English till 27 June 2022, which were examined by applying inclusion/exclusion criteria for data extraction after a two-step screening process.

The long-term or chronic hepatitis C and HIV coinfection is a substantial risk factor for Cirrhosis. Primary etiologies identified causing fibrosis, and the rapid progression of Cirrhosis in HIV/HCV coinfected patients include high-risk alcohol consumption, chronic elevation of ALT, AST, Aspartate Aminotransferase to Platelet Ratio Index (APRI) and Gamma-glutamyl Transferase (GGT), Body Mass Index (BMI), older age, high HIV and HCV viral loads, lower CD4+ count (<250/mm3), and male gender. Comorbidities such as diabetes, hypertension, hyperlipidemia, and high visceral fat area are suggested etiologies of cirrhosis.

The results showed that HIV accelerates the progression of HCV-related liver disease independent of its effect on the immune system. This effect is somehow dependent on age, gender, BMI, duration of HIV infection, and CD4 count.