1
|
Lo Re V, Newcomb CW, Carbonari DM, Roy JA, Althoff KN, Kitahata MM, Reddy KR, Lim JK, Silverberg MJ, Mayor AM, Horberg MA, Cachay ER, Kirk GD, Hull M, Gill J, Sterling TR, Kostman JR, Peters MG, Moore RD, Klein MB, Kim HN. Determinants of Liver Complications Among HIV/Hepatitis B Virus-Coinfected Patients. J Acquir Immune Defic Syndr 2019; 82:71-80. [PMID: 31107304 PMCID: PMC6692181 DOI: 10.1097/qai.0000000000002094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a leading cause of end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in HIV. Factors contributing to the high rates of liver complications among HIV/HBV-coinfected individuals remain unknown. SETTING North American AIDS Cohort Collaboration on Research and Design. METHODS We performed a retrospective cohort study among HIV/HBV-coinfected patients in 10 US and Canadian cohorts of the North American AIDS Cohort Collaboration on Research and Design that validated ESLD (ascites, spontaneous bacterial peritonitis, variceal hemorrhage, and/or hepatic encephalopathy) and HCC diagnoses from 1996 to 2010. Multivariable Cox regression was used to examine adjusted hazard ratios [aHRs with 95% confidence interval (CIs)] of liver complications (first occurrence of ESLD or HCC) associated with hypothesized determinants and with increasing durations of HIV suppression (≤500 copies/mL). RESULTS Among 3573 HIV/HBV patients with 13,790 person-years of follow-up, 111 liver complications occurred (incidence rate = 8.0 [95% CI: 6.6 to 9.7] events/1000 person-years). Rates of liver complication were increased with non-black/non-Hispanic race [aHR = 1.76 (1.13-2.74)], diabetes mellitus [aHR = 2.07 (1.20-3.57)], lower time-updated CD4 cell count [<200 cells/mm: aHR = 2.59 (1.36-4.91); 201-499 cells/mm: aHR = 1.75 (1.01-3.06) versus ≥500 cells/mm], heavy alcohol use [aHR = 1.58 (1.04-2.39)], and higher FIB-4 at start of follow-up [>3.25: aHR = 9.79 (5.73-16.74); 1.45-3.25: aHR = 3.20 (1.87-5.47) versus FIB-4 <1.45]. HIV suppression for ≥6 months was associated with lower liver complication rates compared with those with unsuppressed HIV [aHR = 0.56 (0.35-0.91)]. CONCLUSIONS Non-black/non-Hispanic race, diabetes, lower CD4 cell count, heavy alcohol use, and advanced liver fibrosis were determinants of liver complications among HIV/HBV patients. Sustained HIV suppression should be a focus for HIV/HBV-coinfected patients to reduce the risks of ESLD/HCC.
Collapse
Affiliation(s)
- Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dena M Carbonari
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason A Roy
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Mari M Kitahata
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Rajender Reddy
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph K Lim
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Angel M Mayor
- Department of Medicine, Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Edward R Cachay
- Department of Medicine, University of California, San Diego, CA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Mark Hull
- Department of Medicine, British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Jay R Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA
| | - Marion G Peters
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marina B Klein
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - H Nina Kim
- Department of Medicine, University of Washington, Seattle, WA
| |
Collapse
|
2
|
Adimora AA, Ramirez C, Benning L, Greenblatt RM, Kempf MC, Tien PC, Kassaye SG, Anastos K, Cohen M, Minkoff H, Wingood G, Ofotokun I, Fischl MA, Gange S. Cohort Profile: The Women's Interagency HIV Study (WIHS). Int J Epidemiol 2019; 47:393-394i. [PMID: 29688497 DOI: 10.1093/ije/dyy021] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Adaora A Adimora
- Departments of Medicine and Epidemiology, University of North Carolina School of Medicine, UNC Gillings School of Global Public Health
| | - Catalina Ramirez
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth M Greenblatt
- Departments of Clinical Pharmacology, Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Phyllis C Tien
- Department of Medicine, University of California, and Department of Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Seble G Kassaye
- Division of Infectious Diseases and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Mardge Cohen
- Cook County Health and Hospital System and Department of Medicine, Rush University, Chicago, IL, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Margaret A Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
3
|
Isolated Hepatitis B Core Antibody Status Is Not Associated With Accelerated Liver Disease Progression in HIV/Hepatitis C Coinfection. J Acquir Immune Defic Syndr 2017; 72:274-80. [PMID: 26918547 DOI: 10.1097/qai.0000000000000969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Isolated hepatitis B core antibody (anti-HBc) is a common serologic finding in HIV-infected persons, but the clinical significance is uncertain. We studied HIV/hepatitis C virus (HCV)-infected women over time to determine whether the trajectory of liver disease progression is affected by isolated anti-HBc serologic status. METHODS We performed serial enhanced liver fibrosis (ELF) markers on HIV/HCV-coinfected women to assess liver disease progression trajectory over time comparing women with isolated anti-HBc to women with either negative HB serologies, anti-HBs alone, or anti-HBc and anti-HBs. ELF, a serum marker that combines direct markers of extracellular matrix remodeling and fibrosis, was performed on serum stored biannually. Women with at least 3 ELF determinations and persistent HCV RNA positivity were included. RESULTS Three hundred forty-four women, including 132 with isolated anti-HBc and 212 with other serologic findings, were included. A median of 6 (interquartile range, 5-7) biannual ELF values was available for each woman, totaling 2119 visits. ELF increased over time from a median of 9.07 for women with isolated anti-HBc and 9.10 for those without isolated anti-HBc to 9.83 and 9.88, respectively, with no difference in degree of change or slope in the mixed-effects model including age, race, CD4 count, antiretroviral therapy, and drug and alcohol use. Factors independently associated with liver disease progression were older age, lower CD4, antiretroviral therapy nonuse, and Hispanic ethnicity. CONCLUSION Isolated anti-HBc serologic status was not associated with accelerated liver disease progression over a median of 9.5 years among HIV/HCV-coinfected women.
Collapse
|
4
|
Baranoski AS, Cotton D, Heeren T, Nunes D, Kubiak RW, Horsburgh CR. Clinical Liver Disease Progression Among Hepatitis C-Infected Drug Users With CD4 Cell Count Less Than 200 Cells/mm(3) Is More Pronounced Among Women Than Men. Open Forum Infect Dis 2015; 3:ofv214. [PMID: 26955643 PMCID: PMC4777902 DOI: 10.1093/ofid/ofv214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/24/2015] [Indexed: 12/13/2022] Open
Abstract
The rate of clinical liver disease progression in this cohort of HCV mono-infected and HIV/HCV co-infected individuals was higher than previously reported. Risk of clinical liver disease progression was associated with level of immune suppression, and was more pronounced in women. Background. Hepatitis C virus (HCV) infection is a leading cause of liver-related morbidity and mortality in the United States, and injection drug users are at particularly high risk. Methods. This prospective observational cohort study assessed the rate of, and risk factors for, clinical liver disease progression in a cohort of HCV monoinfected and human immunodeficiency virus (HIV)/HCV coinfected drug users using unadjusted and multivariate Cox proportional hazards regression analyses. Results. Of 564 subjects including 421 (75%) with HIV/HCV coinfection and 143 with HCV monoinfection, 55 (10%) had clinical liver disease progression during follow-up with a rate of 25.3 events per 1000 person-years. In unadjusted analysis, there was an interaction between sex and HIV status. In sex-stratified multivariate analysis, HIV/HCV-coinfected women with CD4 <200 cells/mm3 had 9.99 times the risk of liver disease progression as HCV-monoinfected women (confidence interval [CI], 1.84–54.31; P = .008), and white women had a trend towards increased risk of liver disease progression compared with non-white women (hazard ratio, 2.84; CI, .93–8.68; P = .07). Human immunodeficiency virus/HCV-coinfected men with CD4 <200 cells/mm3 had 2.86 times the risk of liver disease progression as HCV-monoinfected men (CI, 1.23-6.65; P = .01). Conclusions. Hepatitis C virus-monoinfected and HIV/HCV-coinfected drug users had high rates of clinical liver disease progression. In those with HIV infection, liver disease progression was associated with advanced immune suppression. This effect was strikingly more pronounced in women than in men.
Collapse
Affiliation(s)
- Amy S Baranoski
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology; Department of Medicine, Section of Infectious Diseases
| | - Deborah Cotton
- Department of Epidemiology; Department of Medicine, Section of Infectious Diseases
| | - Timothy Heeren
- Department of Biostatistics , Boston University School of Public Health
| | - David Nunes
- Department of Medicine , Section of Gastroenterology , Boston University School of Medicine , Massachusetts
| | | | - C Robert Horsburgh
- Department of Epidemiology; Department of Medicine, Section of Infectious Diseases
| |
Collapse
|
5
|
Sarkar M, Aouzierat B, Bacchetti P, Prokunina-Olsson L, French A, Seaberg E, O'Brien TR, Kuniholm MH, Minkoff H, Plankey M, Strickler HD, Peters MG. Association of IFNL3 and IFNL4 polymorphisms with liver-related mortality in a multiracial cohort of HIV/HCV-coinfected women. J Viral Hepat 2015; 22:1055-60. [PMID: 26115445 PMCID: PMC4618098 DOI: 10.1111/jvh.12431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/08/2015] [Indexed: 12/22/2022]
Abstract
African Americans coinfected with HIV and hepatitis C virus (HCV) have lower liver-related mortality than Caucasians and Hispanics. While genetic polymorphisms near the IFNL3 and IFNL4 genes explain a significant fraction of racial differences in several HCV-related outcomes, the impact of these variants on liver-related mortality has not been investigated. We conducted a cohort study of HIV/HCV-coinfected women followed in the multicentre, NIH-funded Women's Interagency HIV Study (WIHS) to investigate whether 10 polymorphisms spanning the IFN-λ region were associated with liver-related mortality by dominant, recessive or additive genetic models. We also considered whether these polymorphisms contributed to previously reported differences in liver-related death by race/ethnicity (ascertained by self-report and ancestry informative markers). Among 794 coinfected women, there were 471 deaths including 55 liver-related deaths during up to 18 years of follow-up. On adjusted analysis, rs12980275 GG genotype compared to AG+AA hazards ratios [(HR) 0.36, 95% CI 0.14-0.90, P = 0.029] and rs8109886 AA genotype compared to CC+AC (HR 0.67, 95% CI 0.45-0.99, P = 0.047) were most strongly associated with liver-related death although these associations were no longer significant after adjusting for race/ethnicity (HR 0.41, 95% CI 0.16-1.04, P = 0.060 and HR 0.78, 95% CI 0.51-1.19, P = 0.25, respectively). African American women had persistently lower liver-related death independent of IFN-λ variants (HRs ≤ 0.44, P values ≤ 0.04). The lower risk of death among African American HIV/HCV-coinfected women is not explained by genetic variation in the IFN-λ region suggesting, that other genetic, behavioural and/or environmental factors may contribute to racial/ethnic differences in liver-related mortality.
Collapse
Affiliation(s)
- M Sarkar
- Division of Gastroenterology and Hepatology, Medicine, University of California San Francisco, San Francisco, CA, USA
| | - B Aouzierat
- Nursing, University of California San Francisco, San Francisco, CA, USA
| | - P Bacchetti
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - L Prokunina-Olsson
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - A French
- Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - E Seaberg
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T R O'Brien
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - M H Kuniholm
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - H Minkoff
- Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - M Plankey
- Division of Infectious Diseases, Georgetown University, Washington D.C., USA
| | - H D Strickler
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M G Peters
- Division of Gastroenterology and Hepatology, Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
6
|
Lo Re V, Kallan MJ, Tate JP, Lim JK, Goetz MB, Klein MB, Rimland D, Rodriguez-Barradas MC, Butt AA, Gibert CL, Brown ST, Park LS, Dubrow R, Reddy KR, Kostman JR, Justice AC, Localio AR. Predicting Risk of End-Stage Liver Disease in Antiretroviral-Treated Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients. Open Forum Infect Dis 2015; 2:ofv109. [PMID: 26284259 PMCID: PMC4536329 DOI: 10.1093/ofid/ofv109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/05/2015] [Indexed: 12/15/2022] Open
Abstract
Background. End-stage liver disease (ESLD) is an important cause of morbidity among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. Quantifying the risk of this outcome over time could help determine which coinfected patients should be targeted for risk factor modification and HCV treatment. We evaluated demographic, clinical, and laboratory variables to predict risk of ESLD in HIV/HCV-coinfected patients receiving antiretroviral therapy (ART). Methods. We conducted a retrospective cohort study among 6016 HIV/HCV-coinfected patients who received ART within the Veterans Health Administration between 1997 and 2010. The main outcome was incident ESLD, defined by hepatic decompensation, hepatocellular carcinoma, or liver-related death. Cox regression was used to develop prognostic models based on baseline demographic, clinical, and laboratory variables, including FIB-4 and aspartate aminotransferase-to-platelet ratio index, previously validated markers of hepatic fibrosis. Model performance was assessed by discrimination and decision curve analysis. Results. Among 6016 HIV/HCV patients, 532 (8.8%) developed ESLD over a median of 6.6 years. A model comprising FIB-4 and race had modest discrimination for ESLD (c-statistic, 0.73) and higher net benefit than alternative strategies of treating no or all coinfected patients at relevant risk thresholds. For FIB-4 >3.25, ESLD risk ranged from 7.9% at 1 year to 26.0% at 5 years among non-blacks and from 2.4% at 1 year to 14.0% at 5 years among blacks. Conclusions. Race and FIB-4 provided important predictive information on ESLD risk among HIV/HCV patients. Estimating risk of ESLD using these variables could help direct HCV treatment decisions among HIV/HCV-coinfected patients.
Collapse
Affiliation(s)
- Vincent Lo Re
- Departments of Medicine ; Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics , Perelman School of Medicine, University of Pennsylvania , Philadelphia ; Medical Service , Philadelphia VA Medical Center , Pennsylvania
| | - Michael J Kallan
- Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics , Perelman School of Medicine, University of Pennsylvania , Philadelphia
| | - Janet P Tate
- VA Connecticut Healthcare System , West Haven ; Yale University School of Medicine , New Haven, Connecticut
| | - Joseph K Lim
- VA Connecticut Healthcare System , West Haven ; Yale University School of Medicine , New Haven, Connecticut
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , California
| | - Marina B Klein
- Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada
| | - David Rimland
- Atlanta VA Medical Center and Emory University School of Medicine , Georgia
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine , Baylor College of Medicine , Houston, Texas
| | - Adeel A Butt
- VA Pittsburgh Healthcare System , Pennsylvania ; Hamad Healthcare Quality Institute , Doha, Qatar ; Hamad Medical Corporation , Doha, Qatar
| | - Cynthia L Gibert
- Washington DC VA Medical Center , George Washington University Medical Center , Washington, District of Columbia
| | - Sheldon T Brown
- James J. Peters VA Medical Center and Mt. Sinai School of Medicine , New York, New York
| | - Lesley S Park
- Yale University School of Medicine , New Haven, Connecticut ; Yale School of Public Health , New Haven, Connecticut
| | - Robert Dubrow
- Yale University School of Medicine , New Haven, Connecticut ; Yale School of Public Health , New Haven, Connecticut
| | | | | | - Amy C Justice
- VA Connecticut Healthcare System , West Haven ; Yale University School of Medicine , New Haven, Connecticut
| | - A Russell Localio
- Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics , Perelman School of Medicine, University of Pennsylvania , Philadelphia
| |
Collapse
|
7
|
Wojcik GL, Thio CL, Kao WHL, Latanich R, Goedert JJ, Mehta SH, Kirk GD, Peters MG, Cox AL, Kim AY, Chung RT, Thomas DL, Duggal P. Admixture analysis of spontaneous hepatitis C virus clearance in individuals of African descent. Genes Immun 2014; 15:241-6. [PMID: 24622687 PMCID: PMC4308959 DOI: 10.1038/gene.2014.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 12/19/2022]
Abstract
Hepatitis C virus (HCV) infects an estimated 3% of the global population with the majority of individuals (75-85%) failing to clear the virus without treatment, leading to chronic liver disease. Individuals of African descent have lower rates of clearance compared with individuals of European descent and this is not fully explained by social and environmental factors. This suggests that differences in genetic background may contribute to this difference in clinical outcome following HCV infection. Using 473 individuals and 792,721 single-nucleotide polymorphisms (SNPs) from a genome-wide association study (GWAS), we estimated local African ancestry across the genome. Using admixture mapping and logistic regression, we identified two regions of interest associated with spontaneous clearance of HCV (15q24, 20p12). A genome-wide significant variant was identified on chromosome 15 at the imputed SNP, rs55817928 (P=6.18 × 10(-8)) between the genes SCAPER and RCN. Each additional copy of the African ancestral C allele is associated with 2.4 times the odds of spontaneous clearance. Conditional analysis using this SNP in the logistic regression model explained one-third of the local ancestry association. Additionally, signals of selection in this area suggest positive selection due to some ancestral pathogen or environmental pressure in African, but not in European populations.
Collapse
Affiliation(s)
- G L Wojcik
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - C L Thio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W H L Kao
- 1] Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA [2] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Latanich
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J J Goedert
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - S H Mehta
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - G D Kirk
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - M G Peters
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - A L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Y Kim
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R T Chung
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D L Thomas
- 1] Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA [2] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Duggal
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Anderson JP, Tchetgen Tchetgen EJ, Lo Re V, Tate JP, Williams PL, Seage GR, Horsburgh CR, Lim JK, Goetz MB, Rimland D, Rodriguez-Barradas MC, Butt AA, Klein MB, Justice AC. Antiretroviral therapy reduces the rate of hepatic decompensation among HIV- and hepatitis C virus-coinfected veterans. Clin Infect Dis 2013; 58:719-27. [PMID: 24285848 DOI: 10.1093/cid/cit779] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) coinfection accelerates the rate of liver disease outcomes in individuals chronically infected with hepatitis C virus (HCV). It remains unclear to what degree combination antiretroviral therapy (ART) protects against HCV-associated liver failure. METHODS We evaluated 10 090 HIV/HCV-coinfected males from the Veterans Aging Cohort Study Virtual Cohort, who had not initiated ART at entry, for incident hepatic decompensation between 1996 and 2010. We defined ART initiation as the first pharmacy fill date of a qualifying ART regimen of ≥3 drugs from ≥2 classes. Hepatic decompensation was defined as the first occurrence of 1 hospital discharge diagnosis or 2 outpatient diagnoses for ascites, spontaneous bacterial peritonitis, or esophageal variceal hemorrhage. To account for potential confounding by indication, marginal structural models were used to estimate hazard ratios (HRs) of hepatic decompensation, comparing initiation of ART to noninitiation. RESULTS We observed 645 hepatic decompensation events in 46 444 person-years of follow-up (incidence rate, 1.4/100 person-years). Coinfected patients who initiated ART had a significantly reduced rate of hepatic decompensation relative to noninitiators (HR = 0.72; 95% confidence interval [CI], .54-.94). When we removed individuals with HIV RNA ≤400 copies/mL at baseline from the analysis (assuming that they may have received undocumented ART at entry), the hazard ratio became more pronounced (HR = 0.59; 95% CI, .43-.82). CONCLUSIONS Initiation of ART significantly reduced the rate of hepatic decompensation by 28%-41% on average. These results suggest that ART should be administered to HIV/HCV-coinfected patients to lower the risk of end-stage liver disease.
Collapse
|
9
|
Potential role of Hedgehog pathway in liver response to radiation. PLoS One 2013; 8:e74141. [PMID: 24066108 PMCID: PMC3774612 DOI: 10.1371/journal.pone.0074141] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/26/2013] [Indexed: 12/16/2022] Open
Abstract
Radiation-induced fibrosis constitutes a major problem that is commonly observed in the patients undergoing radiotherapy; therefore, understanding its pathophysiological mechanism is important. The Hedgehog (Hh) pathway induces the proliferation of progenitors and myofibroblastic hepatic stellate cells (MF-HSCs) and promotes the epithelial-to-mesenchymal transition (EMT), thereby regulating the repair response in the damaged liver. We examined the response of normal liver to radiation injury. Male mice were sacrificed at 6 weeks and 10 weeks after exposure to a single dose of 6 Gy and the livers were collected for biochemical analysis. Irradiated (IR) and control mice were compared for progenitors, fibrosis, Hh pathway, and EMT at 6 and 10 weeks post irradiation. Fatty hepatocytes were observed and the expressions of Hh ligand, Indian Hh. were greater in the livers at 6 weeks, whereas expression of another Hh ligand, Sonic Hh, increased at 10 weeks post irradiation. Both Smoothened, Hh receptor, and Gli2, Hh-target gene, were up-regulated at 6 and 10 weeks after irradiation. Accumulation of progenitors (CD44, Pan-cytokeratin, and Sox9) was significant in IR livers at 6 and 10 weeks. RNA analysis showed enhanced expression of the EMT-stimulating factor, tgf-β, in the IR livers at 6 weeks and the upregulation of mesenchymal markers (α-SMA, collagen, N-cadherin, and s100a4), but down-regulation of EMT inhibitors, in IR mouse livers at 6 and 10 weeks. Increased fibrosis was observed in IR mouse livers at 10 weeks. Treatment of mice with Hh inhibitor, GDC-0449, suppressed Hh activity and block the proliferation of hepatic progenitor and expression of EMT-stimulating genes in irradiated mice. Therefore, those results demonstrated that the Hh pathway increased in response to liver injury by radiation and promoted a compensatory proliferation of MF-HSCs and progenitors, thereby regulating liver remodeling.
Collapse
|