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Fibrosis associated with clinical outcomes in HIV/HCV coinfected patients

HIV/HCV coinfected patients with advanced hepatic fibrosis were at increased risk for death, end-stage liver disease and carcinomas in a recent study.

A prospective cohort of 638 patients with HCV/HIV coinfection who underwent liver biopsy were monitored via clinical and laboratory evaluations every 3 months for 18 years (median 5.82 years). Hepatic fibrosis stages were measured according to the METAVIR system, and demographics, clinical diagnoses, health-related behaviors and prescribed medications were collected.

At initial biopsy, 69% of patients had been receiving antiretroviral therapy for a median of 1.66 years. No fibrosis (stage F0) was present in 208 patients and minimal (F1) was present in 259, with 60 patients at F2, 41 at F3 and 70 at F4.

Clinical events were observed in 150 cases, including five incidents of hepatocellular carcinoma, 14 of end-stage liver disease (ESLD) and 131 all-cause mortalities. Fifty-one events were considered liver-related. Incidence of outcomes per 1,000 person-years increased according to fibrosis stage, from 23.63 (16.80-33.24) at F0 to 79.43 (55.86-112.95) at F4 (95% CI for both, P<.001 for trend).

Multivariate analysis indicated an independent association between stages F2 through F4 with antiretroviral therapy and death from all causes, as well as incidence of ESLD and hepatocellular carcinoma (RR=2.31, 1.23-4.34 for F2; RR=3.18, 1.47-6.88 for F3; and RR=3.57, 2.06-6.19 for F4; 95% CI for all). Current treatment for HIV was associated with a lower incidence of clinical events (RR=0.27; 95% CI, 0.19-0.38), and liver-related events specifically (RR=0.34; 95% CI, 0.18-0.66).

Among 226 patients who received HCV treatment, patients who were unresponsive were similar to untreated patients with regard to incidence rates of ESLD, carcinoma or all-cause mortality (RR=1.27; 95% CI, 0.86-1.86). No clinical events occurred, however, among 36 participants who achieved sustained virologic response (SVR), or among 15 patients who achieved SVR and subsequently relapsed during HCV treatment.

“Although SVR rates were modest, HCV treatment may benefit patients coinfected with HIV/HCV, particularly those with significant hepatic fibrosis,” the researchers wrote. “Nevertheless, these data highlight the need for more effective HCV treatment regimens for this population; clinical trials of novel combinations of direct-acting antivirals for HCV should be performed as soon as possible.”

Disclosure: See the study for a full list of relevant disclosures.