Abstract
BackgroundLiver disease progression after Hepatitis C Virus (HCV) eradication following direct-acting antiviral (DAA) treatment in the real-life setting according to Human Immunodeficiency Virus (HIV) coinfection was evaluated.MethodsPatients consecutively enrolled in PITER between April 2014 and June 2019 and with at least 12-weeks follow-up following treatment were analysed. Cox regression analysis were used to evaluate HIV coinfection and factors independently associated with liver disease outcomes following viral eradication in DAA treated patients with pre-treatment liver cirrhosis.Results93 HIV/HCV coinfected and 1109 HCV monoinfected patients were evaluated during a median follow-up of 26.7 (range 6–44.6) and 24.6 (range 6.8–47.3) months, respectively. No difference in the cumulative HCC incidence and hepatic decompensation was observed between coinfected and monoinfected patients. Age (Hazard Ratio [HR] = 1.08; 95% CI 1.04–1.13), male sex (HR = 2.76; 95% CI 1.28–5.96), lower albumin levels (HR = 3.94; 95% CI 1.81–8.58), genotype 3 (HR = 5.05; 95% CI 1.75–14.57) and serum anti-HBc positivity (HR = 1.99, 95% CI 1.01–3.95) were independently associated with HCC incidence. Older age (HR = 1.03; 95% CI 1.00–1.07), male sex (HR = 2.13; 95% CI 1.06–4.26) and lower albumin levels (HR = 3.75; 95% CI 1.89–7.46) were independently associated with the appearance of a decompensating event after viral eradication.ConclusionDifferent demographic, clinical and genotype distribution between HIV coinfected vs those monoinfected, was observed in a representative cohort of HCV infected patients in Italy. Once liver cirrhosis is established the disease progression is decreased, but still persists regardless of viral eradication in both coinfected and monoinfected patients. In patients with cirrhosis, HIV coinfection was not associated with a higher probability of liver complications, after viral eradication.
Highlights
Worldwide, approximately 2.3 million people are co-infected with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), giving rise to a global co-infection prevalence in HIV infected individuals of 6.2% [1]
Patients have a faster progression of liver fibrosis, a higher risk of developing cirrhosis, liver decompensation, hepatocellular carcinoma (HCC), and liver-related mortality and this effect is not completely reverted by antiretroviral therapy [2,3,4]
Fibrosis stage was defined based on liver transient elastography data, which were considered as validated if each patient had at least 10 valid stiffness measurements, with a success rate of at least 80%, an interquartile range of less than 30% of the median stiffness score, and a body mass index (BMI) of < 30 kg/m2 [13]
Summary
Approximately 2.3 million people are co-infected with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), giving rise to a global co-infection prevalence in HIV infected individuals of 6.2% [1]. Liver disease progression after Hepatitis C Virus (HCV) eradication following direct-acting antiviral (DAA) treatment in the real-life setting according to Human Immunodeficiency Virus (HIV) coinfection was evaluated. Cox regression analysis were used to evaluate HIV coinfection and factors independently associated with liver disease outcomes following viral eradication in DAA treated patients with pre-treatment liver cirrhosis. HIV coinfection was not associated with a higher probability of liver complications, after viral eradication
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