Progression to Advanced Liver Fibrosis in HIV–HCV-Coinfected Patients and Prioritization of New Hepatitis C Therapies. Issue 8 (November 2014)

• Record Type: Journal Article
• Authors: Labarga, Pablo; Fernández-Montero, Jose V; López, Mariola; Barreiro, Pablo; de Mendoza, Carmen; Sierra-Enguita, Rocío; Treviño, Ana; Soriano, Vincent
• Is Part Of: Antiviral therapy. Volume 19:Issue 8(2014)
• Page Start: 799
• Page End: 803
• Publication Date: 2014-11
• Subjects: Antiviral agents -- Periodicals; Antiviral Agents -- therapeutic use; Virus Diseases -- therapy; Viruses -- drug effects; Antiviral agents; Periodical; Electronic journals; Periodicals; 616.9106
• DOI: 10.3851/IMP2816
• Languages: English
• ISSNs: 1359-6535

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.