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AIDS Research and Treatment
Volume 2012, Article ID 978790, 8 pages
Clinical Study

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

1Infectious Disease of Indiana, PSC, 11455 N. Meridian Street Suite 200, Carmel, IN 46032, USA
2Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
3Jack Martin Coinfection Clinic, Mount Sinai Medical Center, One Gustave L. Levy Place, P.O. Box 1009, New York, NY 10029, USA
4Department of Infectious Diseases, MedStar Washington Hospital Center, 110 Irving Street NW, Room 2A56, Washington, DC 20010, USA

Received 15 May 2012; Accepted 26 September 2012

Academic Editor: Peter Mariuz

Copyright © 2012 Lindsey J. Reese et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 ( ). 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.