Progression to advanced liver fibrosis in HIV-HCV-coinfected patients and prioritization of new hepatitis C therapies.

Abstract

BACKGROUND:

Because of their high cost, the use of direct-acting antivirals (DAAs) is being restricted by many governments to chronic HCV-infected individuals with advanced liver fibrosis. However, response rates are lower and toxicities more frequent in this subset of patients.

METHODS:

All HIV-HCV-coinfected patients followed for at least 3 years at one reference clinic were identified. Liver fibrosis progression (LFP) was defined as a shift from Metavir F0-F2 to F3-F4 estimates (>9.5 KPa) using elastometry.

RESULTS:

A total of 527 HIV-HCV-coinfected patients were identified, of whom 344 had F0-F2 at baseline. Pegylated interferon/ribavirin therapy was given to 205 patients with null/mild fibrosis, of whom 92 (44.9%) achieved sustained virological response (SVR). After a mean follow-up of 53 months, LFP occurred in 5.4% SVR, 25.7% non-SVR and 18% untreated patients (P=0.005). In multivariate analysis, only achievement of SVR prevented LFP (adjusted hazard ratio 2.1; 95% CI 1.1, 4.1; P=0.01). In 139 untreated patients, only greater baseline elastometry values predicted LFP in multivariate analysis (adjusted hazard ratio 1.84; 95% CI 1.03, 3.3; P=0.03). The area under the receiver operating characteristic (AUROC) curve was 79%. A discriminant threshold of 7.1 kPa gave 68% sensitivity and 82% specificity.

CONCLUSIONS:

In the absence of successful treatment, more than 20% of HIV-HCV-coinfected patients with null/mild liver fibrosis progress to advanced fibrosis within 5 years. Patients with >7.1 kPa (Metavir F2) display the highest risk. Therefore, all coinfected patients with any significant liver fibrosis should be considered as candidates for new DAA-based therapies.

• Authors: Pablo Labarga, Jose V Fernández-Montero, Mariola López, Pablo Barreiro, Carmen de Mendoza, Rocío Sierra-Enguita, Ana Treviño, Vincent Soriano
• Journal: Antiviral therapy (Antivir Ther) Vol. 19 Issue 8 Pg. 799-803 ( 2014) ISSN: 2040-2058 [Electronic] England
• PMID: 24964405 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Coinfection
• Disease Progression
• Elasticity Imaging Techniques
• Female
• Follow-Up Studies
• Genotype
• HIV Infections (drug therapy, immunology, virology)
• Hepacivirus (genetics)
• Hepatitis C (complications, drug therapy, virology)
• Humans
• Liver Cirrhosis (diagnosis, etiology)
• Male
• Middle Aged
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome
• Viral Load