Effects of Angiotensin Converting Enzyme Inhibitors on Liver Fibrosis in HIV and Hepatitis C Coinfection

الملخص EN

Background.

Liver fibrosis is accelerated in HIV and hepatitis C coinfection, mediated by profibrotic effects of angiotensin.

The objective of this study was to determine if angiotensin converting enzyme inhibitors (ACE-Is) attenuate liver fibrosis in coinfection.

Methods.

A retrospective review of 156 coinfected subjects was conducted to analyze the association between exposure to ACE-Is and liver fibrosis.

Noninvasive indices of liver fibrosis (APRI, FIB-4, Forns indices) were compared between subjects who had taken ACE-Is and controls who had not taken them.

Linear regression was used to evaluate ACE-I use as an independent predictor of fibrosis.

Results.

Subjects taking ACE-Is for three years were no different than controls on the APRI and the FIB-4 but had significantly higher scores than controls on the Forns index, indicating more advanced fibrosis.

The use of ACE-Is for three years remained independently associated with an elevated Forns score when adjusted for age, race, and HIV viral load (P<0.001).

There were significant associations between all of the indices and significant fibrosis, as determined clinically and radiologically.

Conclusions.

There was not a protective association between angiotensin inhibition and liver fibrosis in coinfection.

These noninvasive indices may be useful for ruling out significant fibrosis in coinfection.