December 14, 2013

High Risk of Decompensation with Precirrhosis in HIV/HCV + People

Author: Mark Mascolini

14 December 2013


People with precirrhosis and HIV/HCV coinfection run a high risk of liver decompensation, according to results of an 892-person analysis in Spain. The researchers believe precirrhosis patients with HIV/HCV should begin immediate anti-HCV therapy.

Liver decompensation is an advanced cirrhosis stage in which the liver can no longer function normally. Understanding which patients with cirrhosis run a high risk of decompensation is critical to prioritizing therapy. A group of Spanish clinical investigators conducted this study to determine risk of decompensation in HIV/HCV-coinfected patients with fibrosis.

The study involved 892 coinfected people who had not taken anti-HCV therapy or did not have a sustained virologic response to HCV therapy. Fibrosis was staged by biopsy in 317 people (35.5%) and by liver stiffness measurement in 575 (64.5%). The researchers defined precirrhosis as a liver stiffness measurement of 9.5 to 14.5 kilopascals and cirrhosis as a measurement of 14.6 kilopascals or greater.

Among the 317 patients staged by biopsy, the probability of remaining free of decompensation was statistically similar for people with F3 versus F4 fibrosis at 1 year: 99% (95% confidence interval [CI] 95% to 100%) versus 96% (95% CI 91% to 98%). But at 3 years the probability of remaining free of decompensation was significantly greater with F3 versus F4 fibrosis: 98% (95% CI 94% to 100%) versus 87% (95% CI 81% to 92%).

Multivariate analysis identified only one factor independently associated with liver decompensation in biopsy patients: Having F4 versus F3 fibrosis doubled the risk of decompensation (subhazard ratio 2.1, 95% CI 1.07 to 4.1, P = 0.032).

Among the 575 patients staged by liver stiffness measurement, the probability of remaining free of decompensation at 1 year approached significance when comparing F3 versus F4 fibrosis: 99% (95% CI 96% to 100%) versus 93% (95% CI 89% to 96%). The difference in decompensation risk between F3 and F4 fibrosis reached significance at 3 years: 97% (95% CI 94% to 99%) versus 83% (95% CI 77% to 87%).

In people evaluated by liver stiffness measurement, having cirrhosis rather than precirrhosis independently raised the risk of decompensation more than 5 times (subhazard ratio 5.67, 95% CI 2.27 to 14.2, P < 0.0001). A platelet count below versus above 100,000 almost doubled the risk of decompensation (subhazard ratio 1.86, 95% CI 1.10 to 3.42, P = 0.046).

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

Source: Juan Macías, Manuel Márquez, Francisco Téllez, Dolores Merino, Patricia Jiménez-Aguilar, Luis F. López-Cortés, Enrique Ortega, Miguel A. von Wichmann, Antonio Rivero, María Mancebo, Jesús Santos, Montserrat Pérez-Pérez, Ignacio Suárez-Lozano, Alberto Romero-Palacios, Almudena Torres-Cornejo, Juan A. Pineda. Risk of liver decompensation among HIV/hepatitis C virus-coinfected individuals with advanced fibrosis: implications for the timing of therapy. Clinical Infectious Diseases. 2013; 57: 1401-1408.

For the study abstract
(Downloading the complete article requires a subscription to the Clinical Infectious Diseases or an online payment; the abstract is free.)

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