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Delayed HCV therapy may increase liver-related deaths

SEATTLE — Deferring treatment for hepatitis C virus infection 1 year or more after diagnosis or until evidence of advanced liver disease may increase liver-related mortality, according to data presented at CROI 2015.

“There has been debate on whether it is safe to defer HCV therapy until advanced liver disease, especially in people who live with HIV who often have other risk factors for liver disease progression,” Cindy Zahnd, researcher at the Institute of Social and Preventive Medicine, University of Bern in Switzerland, said during her presentation. “This is exactly what we wanted to assess, by modeling the impact of deferring HCV therapy until advanced liver disease, stages F3 or F4, vs. treating them sooner.”

Zahnd and colleagues developed an individual-based model of liver disease progression using observed data from a cohort of men who have sex with men from the Swiss HIV Cohort Study coinfected with HIV/HCV and with published data. The researchers followed patients from diagnosis of HCV infection through levels of care. Liver-related events and duration of detectable viral load were compared at treatment of all patients 1 month after diagnosis, 1 year after diagnosis or as they reached fibrosis stage F2, F3 or F4.  

 “If treatment is deferred until F3 instead of being provided in F2, then the percentage of liver-related deaths was doubled,” Zahnd said.

Overall, the model showed that delaying treatment until 1 year after HCV diagnosis led to 14 additional liver-related deaths per 1,000 HCV infections vs. treating patients 1 month after diagnosis. Delaying treatment until stage F2 led to 43 additional deaths, treatment at F3 led to 142 additional deaths and treatment at F4 led to 418 additional deaths, compared with treating patients 1 month after diagnosis, according to the research.

“Deferring HCV therapy also has implications in terms of the risk of HCV transmission, so we calculated the average duration of infectiousness and — no surprise — if treatment is deferred then the average infectious duration increases,” Zahnd said. “Whether people are treated a month or year after their HCV diagnosis, according to our model, did not really matter, [but…] if treatment was deferred until F4 instead of being provided soon after diagnosis, the average infectious duration was increased fourfold.”

Beginning treatment 1 month after diagnosis showed that the average person would have the infection for 5 years vs. treatment at F3 or F4, where the person would be infected with HCV for approximately 15 and 20 years, according to the presentation. – by Melinda Stevens

Reference:

Zahnd C, et al. Abstract 150.  Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.

Disclosure: The researchers report no relevant financial disclosures.