Viral Suppression Helps Combat Long-Term Liver Damage

Liver disease remains to be a leading cause of serious illness and death in HIV-positive people. According to the Centers for Disease Control and Prevention, nearly 25 percent of poz people in the United States also have hepatitis C, one of the most important causes of chronic liver disease. Now, researchers are taking it a step further. 

German researchers report in PLOS One that while hep C is the strongest risk factor for long-term liver damage, long-term survivors who were first treated with didanosine (DDI) and zidovudine (AZT) for HIV are also just as likely to have liver conditions like fibrosis and cirrhosis — and viral suppression helps protect against long-term liver damage caused by the older drugs. 

HIV-positive people are living proof that today’s effective antiretroviral treatment is a miracle. DDI and AZT are no longer used in routine HIV care to the high quantities they once were. Treatment today suppresses the virus to such low levels that it becomes undetectable, or impossible to transmit to an HIV-negative person. 

The German study shows strong evidence that viral suppression with antiretroviral therapy has cut the risk of liver fibrosis in long-term survivors previously exposed to DDI or AZT, nearly in half. 

“This study demonstrates that history of DDI intake and AZT intake are independently associated with the presence of significant fibrosis and cirrhosis,” the authors commented. “Importantly, sufficient suppression of HIV replication protected from significant liver fibrosis…for the wide range of mono-infected patients, the strongest protection against development of liver fibrosis seems to be sufficient HIV-replication control, which outweighs the damage of previous cART [combination antiretroviral therapy] regimens with drugs such as DDI and AZT.”

Researchers at the University of Bonn sought out to study why older anti-HIV treatments are associated with significant fibrosis and cirrhosis by studying 333 HIV-positive people who received care between 2009 and 2011. 

Eighty-nine percent of the total number of people were on antiretrovirals and being treated for at least five years, and over 25 percent of the participants had contracted HIV via injection drug use. One-third of the participants also had hep C, and 25 percent had a history of stavudine (Zerit) exposure and 12 percent had taken DDI. Overall, 18 percent of people had significant fibrosis and 8 person had cirrhosis, reports NAM’s AIDS Map. 

“Our study demonstrates that a history of DDI and AZT treatment still bears an unfavorable influence on the presence of liver disease,” the authors stated. “Control of HIV replication seems to be the master switch in hampering development of liver fibrosis in HIV patients.”