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09/18/2013

Support for Treatment of HCV in Co-infected Patients with Moderate Fibrosis Reported at ICAAC 2013


Liver disease is a common comorbidity that is among the leading causes of death in HIV. It results predominantly from complications HCV infection. Following antiviral treatment of HCV, a sustained virologic response (SVR), has been shown to reduce liver-related clinical events and all cause mortality in both HCV mono-infected and HIV/HCV co-infected patients. Current treatment is arduous and is often deferred in patients with milder degrees of liver fibrosis. However, HCV treatment is undergoing rapid advances. In the near future it should be possible to cure most patients with shorter and better tolerated, but also very expensive antiviral regimens. Therefore, it is important to identify the optimal time to treat HCV in co-infected patients.

Berenguer et al reviewed the clinical outcome in 695 HIV/HCV co-infected patients with non-advanced liver fibrosis (Metavir F0, 1, 2) who were treated with ribavirin plus interferon between 2000-2008 at 19 centers in Spain. Thirty-five percent achieved an SVR. As would be expected, SVR patients had lower baseline HCV RNA, more HCV genotype 2 or 3 infection and less heavy alcohol use than non-SVR patients. During follow-up through July 2010, liver events, liver decompensation, liver-related mortality and all cause mortality were significantly lower in the SVR group. All differences were driven by the subset with F2 fibrosis. Those with F0 and F1 did not benefit significantly. In a multivariable analysis adjusting for age, gender, injection drug use, CD4, CDC class, HCV genotype and baseline HCV RNA, SVR was associated with an 89% decrease in the risk of liver-related events in the F2 group (p=0.035). This study is a cohort analysis in which the assignment to treatment was not randomized. There are likely other differences between patients who do or do not achieve and SVR that were not adjusted for and may confound the results. Nevertheless, the magnitude of the benefit of achieving an SVR for those with F2 fibrosis is large enough that it probably cannot be fully explained by confounding. These findings suggest all patients with HIV/HCV co-infection and F2 or greater fibrosis should be treated for HCV, especially when new treatments that greatly increase the likelihood of SVR become available.

Reference:
Berenguer J, Zamora FX, Díez C, et al. Hepatitis C Eradication Reduces Liver Decompensation, HIV Progression, and Death in HIV/HCV-Coinfected Patients with Non-Advanced Liver Fibrosis. 53rd ICAAC, Denver CO, Sept 10-13, 2013, Abstract H-1527.


Source: Reporting from Denver for the PRN News: David H Shepp, MD