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Macias J. Clin Infect Dis. 2013;doi:10.1093/cid/cit537.
August 15, 2013
Hepatitis C therapy is necessary in patients with advanced fibrosis who are coinfected with hepatitis C and HIV because they are at risk for liver decompensations, researchers in Spain have suggested.
“Liver fibrosis progresses fast among HIV/HCV-coinfected patients and, as a consequence, after the first decompensation patients die soon,” the researchers wrote in Clinical Infectious Diseases. “This grim prognosis can be altered by therapy against HCV. Individuals with HIV infection and compensated HCV-related cirrhosis achieving sustained virological response to therapy against HCV are at a reduced risk of liver events.”
The retrospective cohort study included 892 patients with HIV/HCV coinfection who were treated from November 1990 to June 2012. They had not previously received HCV therapy or had received treatment but not reached sustained virological response. All patients had advanced fibrosis diagnosed by liver biopsy or liver stiffness measurement. The researchers evaluated the number of liver decompensations recorded during the follow-up period.
Among the 317 patients who had liver biopsy, 40 patients experienced liver decompensation, with a rate of 2.3 decompensations per 100 person-years. At 5 years, the probability of remaining free of liver decompensation was 90%. Twelve patients with fibrosis stage 3 at baseline developed liver decompensation, for an incidence of 1.4 per 100 person-years. Twenty-eight patients with cirrhosis at baseline developed liver decompensation, for an incidence of 3.1 per 100 person-years.
Among the 575 patients who had liver stiffness measurement, 53 patients experienced liver decompensation, with a rate of 3.98 decompensations per 100 person-years. At 5 years, the probability of remaining free of liver decompensation was 77%. Six individuals with a liver stiffness measurement of ≥9.5 kiloPascal (KPa) and <14.5 KPa and 47 patients with a measurement of ≥14.6 KPa at baseline experienced decompensations of cirrhosis. The incidence rates were 0.9 per 100 person-years and 4 per 100 person-years, respectively.
“Liver decompensations among HIV/HCV-coinfected patients can emerge shortly after the detection of advanced fibrosis,” the researchers wrote. “In those patients, immediate anti-HCV therapy should be considered.”
Disclosure: Some of the researchers report financial relationships with Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Jansen Cilag, Merck Sharp & Dome, Roche, Schering-Plough and ViiV.
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