Effect of HCV treatment with DAAs on serum Intestinal Fatty Acid Binding Protein (I-FABP) as a marker of intestinal permeability in HCV/ HIV co- infected patients

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Background: HCV and HIV co-infected patients develop cirrhosis more rapidly than HCV mono-infection. Intestinal injury and microbial translocation are postulated mechanisms for rapid progression of cirrhosis. Aim: Study the effect of HCV treatment with DAAs on serum Intestinal Fatty Acid Binding Protein (I-FABP) as a marker of intestinal injury in HCV/ HIV co-infected patients and its relation to hepatic fibrosis. Comparing the level of I-FABP in HCV mono-infection and HCV/ HIV co-infection was a secondary aim.Methods: I–FABP levels were measured in 50 non-cirrhotic HCV/HIV co-infected patients pre and post HCV treatment (SVR 12) and in 25 chronic HCV patients as a control group. Hepatic fibrosis was assessed by FIB4 score, APRI score and transient Elastography. Results: HCV/ HIV co-infected patients had significantly higher levels of I-FABP compared to the HCV-mono-infected patients (P = 0.001). After HCV treatment in HCV/HIV co-infected patients, I-FABP level was significantly elevated (P <0.001) and was positively correlated to baseline FIB4 values and serum ALT level (r = 0.283, p value = 0.047) and (r= 0.340, P value = 0.016), respectively.Conclusion: HCV/HIV co-infection is associated with significantly higher intestinal injury and subsequent hepatic fibrosis than HCV mono-infection. HIV infection is associated with intestinal epithelial injury and microbial translocation and may play a role in the persistence of systemic inflammation after HCV eradication.