Human Immunodeficiency Virus/Hepatitis C Virus (HCV) Co‐infected Patients With Cirrhosis Are No Longer at Higher Risk for Hepatocellular Carcinoma or End‐Stage Liver Disease as Compared to HCV Mono‐infected Patients

Abstract

It is widely accepted that human immunodeficiency virus (HIV) infection is a risk factor for increased severity of hepatitis C virus (HCV) liver disease. However, owing to better efficacy and safety of combination antiretroviral therapy (cART), and increased access to HCV therapy, whether this condition remains true is still unknown. Overall, 1,253 HCV mono‐infected patients and 175 HIV/HCV co‐infected patients with cirrhosis, included in two prospective French national cohorts (ANRS CO12 CirVir and CO13 HEPAVIH), were studied. Cirrhosis was compensated (Child‐Pugh A), without past history of complication, and assessed on liver biopsy. Incidences of liver decompensation (LD), hepatocellular carcinoma (HCC), and death according to HIV status were calculated by a Fine‐Gray model adjusted for age. Propensity score matching was also performed to minimize confounding by baseline characteristics. At baseline, HIV/HCV patients were younger (47.5 vs. 56.0 years; P < 0.001), more frequently males (77.1% vs. 62.3%; P < 0.001), and had at baseline and at end of follow‐up similar rates of HCV eradication than HCV mono‐infected patients. A total of 80.4% of HIV/HCV patients had an undetectable HIV viral load. After adjustment for age, 5‐year cumulative incidences of HCC and decompensation were similar in HIV/HCV and HCV patients (8.5% vs. 13.2%, P = 0.12 and 12.8% vs. 15.6%, P = 0.40, respectively). Overall mortality adjusted for age was higher in HIV/HCV co‐infected patients (subhazard ratio [SHR] = 1.88; 95% confidence interval [CI], 1.15‐3.06; P = 0.011). Factors associated with LD and HCC were age, absence of sustained virological response, and severity of cirrhosis, but not HIV status. Using a propensity score matching 95 patients of each group according to baseline features, similar results were observed. Conclusion: In HCV‐infected patients with cirrhosis, HIV co‐infection was no longer associated with higher risks of HCC and hepatic decompensation. Increased mortality, however, persisted, attributed to extrahepatic conditions.

Mild profile improvement of immune biomarkers in HIV/HCV-coinfected patients who removed hepatitis C after HCV treatment: A prospective study

“…22 , 23 The elimination of HCV infection after HCV therapy (sustained virologic response (SVR)) in HIV/HCV-coinfected patients decreases the risk of clinical events and death. [24][25][26] However, cirrhotic patients who achieve SVR remain at risk of developing hepatocellular carcinoma 27 and extrahepatic cancers. 28 Additionally, reversal of cirrhosis after SVR seems to be a slow process and the alterations of the immune system may persist after achieving SVR, particularly in cirrhotic patients.…”

Viral hepatitis as a risk factor for the development of hepatocellular carcinoma

“…However, recent data from two prospective French cohorts demonstrate that this is no longer the case in the current context of more effective combination antiretroviral therapies and increased access to HCV therapy. In this analysis, the 5-year cumulative incidence of HCC and liver decompensation did not differ significantly between HIV/HCV coinfected and HCV mono-infected patients (8.5% vs. 13.2%, P = 0.12 and 12.8% vs. 15.6%, P = 0.40, respectively) [90] . Also, patients with a dual HBV/HCV infection have a higher risk of progression to cirrhosis and decompensated liver disease compared to patients with an HCV mono-infection [91,92] .…”

Letter to the Editor: Coinfection of Human Immunodeficiency Virus With Hepatitis C Virus: A Change of Paradigm

“…We have read with interest the paper by Salmon‐Ceron et al Although the results show an increase in overall mortality in human immunodeficiency virus (HIV)/hepatitis C virus (HCV)–coinfected patients, the similar risk of developing hepatocellular carcinoma (HCC) compared to HCV‐monoinfected patients, somewhat unexpected, was not surprising for us.…”

“…More recently, we reviewed data from 399 coinfected and 405 monoinfected patients in southern Brazil, demonstrating the absence of correlation between HIV coinfection and the increase in HCC incidence . Unlike the study by Salmon‐Ceron et al, our population also included patients without cirrhosis, and coinfected patients were more frequently non‐Caucasians ( P = 0.006) and less frequently infected by HCV genotype 3 ( P = 0.005). Coinfected patients had an HCC incidence rate of 0.25 cases per 100 patient‐years, while monoinfected patients had an incidence rate of 0.72 ( P = 0.003).…”