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

Esmaeil Mehraeen1, Nazanin Janfaza2, Ramin Shahidi3, Arian Afzalian4, Sanaz Varshochi4, Reyhaneh Jashaninejad5, 6, Ava Pashaei7, Marcarious M. Tantuoyir4, 8, Muhammed Camara9, Parinaz Paranjkhoo10, Zohal Parmoon5, Shahmohamadi Elnaz4, Roghayeh Salmani11, Parisa Matini12, Pegah Mirzapour5, Hooman Ebrahimi13, Ali Moradi4, SeyedAhmad SeyedAlinaghi5, *, Shayesteh Jahanfar14
1 Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
2 Department of Internal Medicine, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3 School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
4 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5 Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
6 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
7 School of Nursing, University of British Columbia, Vancouver, Canada
8 Biomedical Engineering Unit, University of Ghana Medical Center (UGMC), Accra, Ghana
9 Edward Francis Small Teaching Hospital, Banjul, The Gambia
10 Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
11 Department of Midwifery, Khalkhal University of Medical Sciences, Khalkhal, Iran
12 School of Medicine, Iran University of Medical Sciences, Tehran, Iran
13 Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
14 Department of Public Health and Community Medicine, Tufts University School of Medicine, United States

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© 2024 The Author(s). Published by Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran; Postal Code: 1419733141; Tel: +98-9126448153, Fax: +98-21-66581565; E-mail:



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.

Keywords: Cirrhosis, Hepatitis C, HCV, HIV, AIDS.