Z Gastroenterol 2011; 49 - P8
DOI: 10.1055/s-0031-1279845

A prospective evaluation of hepatic, systemic and pulmonary hemodynamics in HIV-HCV coinfected patients prior and after antiviral therapy

T Reiberger 1, A Ferlitsch 1, BA Payer 1, W Sieghart 1, A Rieger 1, M Peck-Radosavljevic 1
  • 1Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology & Hepatology (Vienna Hepatic Hemodynamic Lab)

Introduction: Patients coinfected with HIV and hepatitis C virus (HCV) are at risk for developing portal hypertension and alteration in pulmonary and systemic hemodynamics. Wheter this risk can be influenced by antiviral therapy with pegylated interferon-alpha (PEGIFN) and ribavirin (RBV) is unclear.

Methods: Hemodynamic parameters including portal pressure (HVPG), pulmonary arterial pressure (meanPAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO) and systemic vascular resistance index (SVRI) were evaluated during a prospective trial (HIVCOPEG) prior to and after antiviral therapy with PEGIFN+RBV.

Results: 78 HIV-HCV coinfected patients were evaluated (age:38y, HCV-GT1:54%, HCV-RNA: 4.52E6 IU/mL, F1/F2/F3/F4: 15/33/16/14; CD4+ cells: 517/µL, HAART:71%). Baseline evaluation showed a meanPAP of 14.7±4.2mmHg, a CO of 6.2±1.5 L/min, a PCWP of 6.9±2.7mmHg, a SVRI 2173±624dyn/s/cm5/m2, and an HVPG of 4.6±3.7mmHg. Thirty patients (38%) with advanced fibrosis (F3/F4 pooled for analysis) had signifcantly higher CO (p=0.027) and lower SVRI than patients with lower fibrosis stages (F≤2). MeanPAP (p=0.018) and PCWP (p=0.036) were significantly lower in patients with F≤2 than in F3/4 patients. Pulmonary hypertension (meanPAP>25mmHg) and elevated portal pressure (HVPG>5mmHg) was diagnosed in 3 (4%) and 18 (23%) patients, respectively. In 28 patients with available follow-up measurements no significant effects of PEGIFN+RBV on meanPAP, PCWP, CO, SVRI were observed, while HVPG was significantly decreased (4.8±2.2 vs. 3.2±1.7mmHg; p=0.013).

Conclusions: Advanced fibrosis in HIV-HCV coinfected patients is associated with hyperdynamic circulation (as shown by higher CO and peripheral vasodilation (lower SVRI). The meanPAP is higher in patients with advanced fibrosis than in patients with lower fibrosis stages, while the overall incidence of pulmonary hypertension is low (4%) in patients with HIV-HCV coinfection. HVPG increases with advanced fibrosis with up to 23% of HIV-HCV coinfected patients developing an elevated portal pressure. Antiviral therapy with PEGIFN+RBV seems to decrease HVPG without significant effects on pulmonary or systemic hemodynamics.