Periportal CD4⁺ cell infiltration increases in HIV/hepatitis C virus-coinfected patients commencing ART, whereas CD8⁺ cells clear from the liver

Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is common in Asia, but the effects of antiretroviral therapy (ART) are unclear. Histopathological changes in the liver are described in a prospective study of HCV-seropositive HIV-infected patients at Cipto Mangunkusomo Hospital (Jakarta, Indonesia). Liver biopsy specimens were collected at baseline (n = 48) and 48 weeks (n = 34). Ishak scores showed mild but detectable inflammation and/ or fibrosis. Levels of portal inflammation declined during ART (P = .03), whereas fibrosis remained (P = .11). Portal infiltration of CD4⁺ cells increased during ART (P < .0001), whereas infiltration of CD8 ⁺ cells subsided. Numbers of CD4⁺ cells in the liver at baseline correlated with circulating CD4⁺ T-cell counts (P = .03-.05). Numbers of liver-infiltrating CD4⁺ and CD8⁺ cells at baseline were not associates with subsequent experience of an immune restoration disease, which is defined by a rise in alanine transaminase levels during ART.