April 13, 2013

HCV Clearance Key to Liver Fibrosis Regression

Megan Brooks

Mar 28, 2013

In patients coinfected with human immunodeficiency virus (HIV) and hepatitis C, sustained clearance of hepatitis-RNA after a course of antiviral treatment is "the major" determinant of liver fibrosis regression, according to new research.

The lack of hepatitis C virus treatment increases the "probability of developing advanced liver fibrosis," said study investigator Vincent Soriano, MD, from Hospital Carlos III in Madrid, Spain.

Dr. Soriano presented the findings at the International Conference on Viral Hepatitis 2013 in New York City, which was sponsored by the International Association of Providers of AIDS Care and the Icahn School of Medicine at Mount Sinai.

Dr. Soriano's team studied 498 patients coinfected with HIV and hepatitis C who had undergone longitudinal assessment of liver fibrosis with elastometry (FibroScan).

On the basis of response to peginterferon and ribavirin treatment, patients were categorized into 1 of 5 groups: sustained virologic responders, relapsers, partial responders, null responders, treatment-naïve patients.

Table. Response to Peginterferon and Ribavirin Treatment

Response n %
Sustained virologic responders 138 27.7
Relapsers 40 8.0
Partial responders 61 12.2
Null responders 71 14.3
Treatment-naïve patients 188 37.8

After a median follow-up of 53 months, there was less liver fibrosis progression in the sustained virologic responders (7.2%) than in the relapsers (25.0%; P = .002), the partial responders (23.0%; P = .002), the null responders (29.6%; P < .001), and the treatment-naïve patients (19.7%; P = .002).

In addition, cirrhosis regression was more frequent in the sustained virologic responders (11.0%) than in the null responders (2.8%; P = .04) and the treatment-naïve patients (1.6%; P < .001). Regression to liver fibrosis stage F0 to F2 or a decrease in liver stiffness greater than 30% was more frequent in the sustained virologic responders than in the treatment-naïve patients (21.7% vs 7.4%; P < .001). Median liver stiffness decreased significantly in the sustained virologic responders (P < .001) and increased in the null responders (P = .01).

"This study shows the benefit of the successful treatment of hepatitis C and the benefits on the potential for serious liver disease in the future," conference cochair Mark Nelson, MD, from Chelsea and Westminster Hospital, London, United Kingdom, told Medscape Medical News.

Dr. Nelson added that "this shows the importance of rapid and widespread access to more successful therapies for hepatitis C in reducing the high levels of morbidity and mortality secondary to hepatitis C–associated liver disease in the HIV population."

Dr. Soriano reports financial relationships with Boehringer Ingelheim Pharmaceuticals, Gilead Sciences, Janssen Pharmaceuticals, Merck & Co, and AbbVie. Dr. Nelson reports relationships with Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, Merck Sharpe & Dohme, ViiV Healthcare, and AbbVie.

International Conference on Viral Hepatitis (ICVH) 2013: Oral Abstract 8. Presented March 25, 2013.

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