Risk of Liver Decompensation Among HIV/HCV Coinfected Individuals With Advanced Fibrosis: Implications for the Timing of Therapy

Risk of Liver Decompensation Among HIV/Hepatitis C Virus–Coinfected Individuals With Advanced Fibrosis: Implications for the Timing of Therapy

CORRECTED PROOF

Clin Infect Dis. (2013) doi: 10.1093/cid/cit537 First published online: August 14, 2013

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Juan Macías1, Manuel Márquez2, Francisco Téllez3, Dolores Merino4, Patricia Jiménez-Aguilar5, Luis F. López-Cortés6, Enrique Ortega7, Miguel A. von Wichmann8, Antonio Rivero9, María Mancebo1, Jesús Santos2, Montserrat Pérez-Pérez3, Ignacio Suárez-Lozano4, Alberto Romero-Palacios5, Almudena Torres-Cornejo6, and Juan A. Pineda1

+ Author Affiliations

Correspondence: Juan Antonio Pineda, MD, PhD, Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda Bellavista s/n, Sevilla 41014, Spain (japineda@telefonica.net).

Abstract

Background. Most human immunodeficiency virus (HIV)/hepatitis C virus (HCV)–infected patients who are currently receiving boceprevir or telaprevir-based therapy against HCV show cirrhosis. However, the risk of liver decompensation (DC) among HIV/HCV-coinfected patients with stage 3 fibrosis in the short term could be high enough to not allow delays. We aimed at assessing the risk of DC among HIV/HCV-coinfected individuals with advanced fibrosis (F3–F4).

Methods. Eight hundred ninety-two HIV/HCV-coinfected patients, naive or without sustained virologic response to HCV therapy, were included in this cohort. Fibrosis was staged by biopsy in 317 patients and by liver stiffness measurement (LSM) in 575 individuals. Precirrhosis was defined as an LSM of 9.5–14.6 kilopascals (kPa), and cirrhosis as an LSM of ≥14.6 kPa.

Results. For patients with biopsy, the probability of remaining free of DC for F3 vs F4 was 99% (95% confidence interval [CI], 95%–100%) vs 96% (95% CI, 91%–98%) at 1 year, and 98% (95% CI, 94%–100%) vs 87% (95% CI, 81%–92%) at 3 years. The only factor independently associated with DC was fibrosis stage (F4 vs F3, subhazard ratio [SHR], 2.1; 95% CI, 1.07–4.1; P = .032). For patients with LSM, the probability of remaining free of DC for precirrhosis vs cirrhosis was 99% (95% CI, 96%–100%) vs 93% (95% CI, 89%–96%) at 1 year, and 97% (95% CI, 94%–99%) vs 83% (95% CI, 77%–87%) at 3 years. Factors independently associated with DC were platelet count (<100 × 10³ vs ≥100 × 10³: SHR, 1.86; 95% CI, 1.01–3.42; P = .046) and LSM (cirrhosis vs precirrhosis: SHR, 5.67; 95% CI, 2.27–14.1; P < .0001).

Conclusions. As in patients with cirrhosis, immediate therapy against HCV is warranted for patients with precirrhosis and HIV coinfection, as they are at risk of DC soon after the diagnosis of advanced fibrosis.

Key words: chronic hepatitis C, liver fibrosis, liver decompensations, liver biopsy, liver stiffness

Received April 19, 2013.
Accepted August 4, 2013.

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