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Deferred HCV therapy in MSM with HIV/HCV increases risk for mortality

Men who have sex with men coinfected with HIV and hepatitis C virus who deferred HCV treatment until evidence of advanced liver fibrosis appeared to have an increased risk for mortality and morbidity, according to published findings.

“Our findings support current recommendations to start HCV treatment irrespective of fibrosis stage in those with risk factors for accelerated fibrosis progression, including HIV-coinfected [men who have sex with men], and in persons at elevated risk of HCV transmission,” Andri Rauch, MD, associate professor, department of infectious diseases, Bern University Hospital, Switzerland, and colleagues wrote.

The researchers developed an individual-based model of liver disease progression in men who have sex with men (MSM) with HIV/HCV coinfection enrolled in the Swiss HIV Cohort Study. Liver-related morbidity, mortality and median time of HCV replication when patients were treated in liver fibrosis stages F0, F1, F2, F3 or F4, based on the METAVIR scale.

Overall, 2% of patients died of liver-related complications when treatment was initiated in F0 or F1; 3% died if treatment was deferred until stage F2; 7% died when deferred until stage F3; and 22% died when treatment was deferred to stage F4.

Median time patients had with HCV replication increased from 5 years if treatment was initiated in stage F2 to about 15 years if treatment was deferred until stage F4.

“Our model predicts that the time individuals spend with replicating HCV can be greatly shortened by early treatment,” the researchers wrote. “This may decrease further HCV transmissions in those with high-risk behavior.”

The researchers concluded: “Deferring HCV therapy until advanced liver fibrosis is established could increase liver-related morbidity and mortality in HIV/HCV coinfected individuals, and substantially prolong the time individuals spend with replicating HCV infection.” – by Melinda Stevens

Disclosure: Rauch reports receiving grants and/or honoraria for advising, unrestricted grants and travel grants from AbbVie; Bristol-Myers Squibb; Boehringer Ingelheim; Gilead Sciences; Janssen-Cilag; Merck, Sharp and Dohme; and ViiV Healthcare. Please see the full study for a list of all other authors’ relevant financial disclosures.