ALF was defined as liver stiffness (LS) 9.5 kPa. scores, aspartate aminotransferase platelet ratio index (APRI) and FIB-4, were also used. RESULTS: LS values of co-infected patients were higher than in either HIV or HCV mono-infected patients (2MH= 4,P< 0.04). In fact, LS 9.5 was significantly higher in co-infected than in HIV and HCV mono-infected patients (2= 5,P< 0.03). Also APRI and the FIB-4 index showed more LF in co-infected than in HIV mono-infected patients (P< 0.0001), but not in HCV mono-infected patients. In HIVHCV co-infected patients, the extent of LS was significantly associated with alcohol intake (P< 0.04) and lower CD4+ cell count (P< 0.02). In HCV patients, LS was correlated with alcohol intake (P< 0.001) and cholesterol levels (P< 0.03). Body mass index, diabetes, HCV- and HIV-viremia were not significantly correlated with LS. In addition, 20% of co-infected patients had virologically unsuccessful HAART; in 50% compliance was low, CD4+ levels were < 400 cells/mm3and LS was > 9.5 kPa. There was no significant correlation between extent of LF and HAART exposure or duration of HAART exposure, in particular with specific dideoxynucleoside analogues. CONCLUSION: ALF was more frequent in co-infected than mono-infected patients. This result correlated with lower CD4 levels. Protective immunological effects of HAART on LF progression outweigh its hepatotoxic effects. Keywords:Liver fibrosis, Transient elastography, Aspartate aminotransferase platelet ratio index, FIB-4 test, Fibrosis evaluation, Human immunodeficiency virus infection, Hepatitis C virus infection == INTRODUCTION == In the last few years, liver disease associated with hepatitis C virus (HCV) has emerged as a significant problem in human immunodeficiency virus (HIV)-infected patients, thanks to improved survival in the highly active anti-retroviral therapy (HAART) era[1]. It has been reported that HIV and HCV co-infection leads to a more rapid progression of liver disease to cirrhosis[2,3]. Other factors such as severe immune suppression and alcohol consumption accelerate the progression of HCV-related fibrosis[4,5]. Virologically successful HAART Telithromycin (Ketek) slows the progression of liver fibrosis (LF) and reduces hepatic necroinflammatory activity in HIV/HCV co-infected patients[2,6]. In contrast, antiretroviral-related liver toxicity could KIF23 contribute to liver damage in HIV- and HIV/HCV-infected patients[7]. Mitochondrial toxicity of nucleoside analogues[8], and glucose or Telithromycin (Ketek) lipid abnormalities, such as hyperglycemia and lipodystrophy, which are particularly common when using some protease inhibitors[9], may produce Telithromycin (Ketek) or enhance LF progression in HIV mono- and HIV/HCV co-infected patients. Currently, in this respect, a growing number of cases of cryptogenetic liver disease in symptomatic and asymptomatic HIV-infected patients has been reported[10,11]. Percutaneous liver biopsy is the gold standard for assessing LF. However, it may be associated with sampling variability[12], is an invasive technique with rates of morbidity of 3% and mortality of 0.03%[13,14], and as a consequence, is not suitable for repeated assessment, which is required when monitoring LF. For these reasons, new noninvasive methods for the assessment of LF have been developed. Transient elastography (TE) (Fibro-Scan; EchoSens, Paris, France) is a rapid, reliable and tolerable imaging technique for the assessment of LF by measuring liver stiffness (LS)[15,16]. On the other hand, many biochemical markers have been implemented to estimate LF, with the aim of reducing the number of liver biopsies[14]. The advent of TE and biochemical markers has been demonstrated to be very helpful in the non-invasive measurement of LF, particularly in asymptomatic HIV-infected patients in whom liver biopsy is not recommended[11]. TE has already been validated for the measurement of LF in HIV and HCV seropositive patients[17,18]. The aim of this study was to assess the prevalence of LF and cirrhosis in a group of HIV mono-infected, HCV mono-infected and HIV/HCV co-infected patients using TE and biochemical markers. In addition, we evaluated which of the factors studied correlated with advanced LF (ALF) and cirrhosis. == MATERIALS AND METHODS == == Study population == Between September 2008 and October 2009 all consecutive HIV mono-infected and HIV/HCV co-infected patients on regular follow-up at the AIDS Center.
