Liver‐related mortality and hospitalizations attributable to chronic hepatitis C virus coinfection in persons living with <scp>HIV</scp>

Mena, Álvaro; Meijide, Héctor; Rodríguez-Osorio, Iria; Castro, Ángeles; Poveda, Eva

doi:10.1111/hiv.12502

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…However, fifty percent of patients with grade 3–4 AEs suffered from chronic hepatitis C and a significant higher proportion of patients with positive HCV-RNA experienced liver AE. We confirmed a low incidence of liver events in patients initiating EVG/COBI/FTC/TDF a described in RCTs [1–4] and the higher rates of abnormal AST and ALT and liver decompensation in antiretroviral treated patients with HIV-HCV coinfection as described in literature [14, 15]. Data are lacking about specific hepatic toxicity of EVG/COBI in patient with chronic HCV viral hepatitis.…”

Section: Discussionsupporting

confidence: 86%

Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project

et al. 2017

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ObjectivesThe study aim was to evaluate the impact on Liver and Kidney toxicity of the single tablet regimen Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate (EVG/COBI/FTC/TDF) on Antiretroviral Therapy (ART) experienced or naïve patients.MethodsPatients initiating EVG/COBI/FTC/TDF were enrolled in the SCOLTA project, a multicenter observational study reporting grade 3–4 Adverse Events in subjects beginning new antiretroviral drug regimens. In this analysis, patients were evaluated at T0 (baseline), T1 (six months) and at T2 (twelve months).ResultsA total of 329 patients were enrolled, and 280 (85.1%) of these had at least one follow-up visit. Median observation time was 11 months (IQR 7.0–15.5). Two hundred and two patients (72.1%) were ART experienced and 78 (27.9%) ART naive. Prevalence of HCV-co-infection was 21.4%. At T1, we observed a significant decline in estimated glomerular filtration rate (eGFR), both in experienced and naive patients (mean change from T0–7.5 ± 12.8 ml/min, -15.5 ± 17.8 ml/min, respectively, p = 0.0005), which was confirmed at T2 (mean change from T0–8.2 ± 15.8 ml/min, -17.6 ± 19.4 ml/min, respectively, p = 0.001). Regarding aspartate aminotransferase (AST) and alanine transaminase (ALT) grade 1–2 modifications, no significant differences were observed between experienced and naïve subjects, but an increased prevalence of abnormal liver function test was observed in patients with chronic HCV infection (p<0.001).ConclusionsA significant decline in eGFR was observed in patients initiating EVG/COBI/FTC/TDF in the first 6 months, with no significant worsening occurring at 12 months vs. 6 months of therapy. Patients with chronic HCV infection were at higher risk to develop abnormal liver tests.

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Section: Discussionsupporting

confidence: 86%

Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project

et al. 2017

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“…A total of 1984 PLHIV initiating ART and were tested for HBV and HCV at baseline (Table 1). The median age of patients was 39 years (IQR [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], and the median CD4+ T-cell count was 152 cells/mm 3…”

Section: Demographic Characteristics and Hepatitis Infection At Basmentioning

confidence: 99%

“…37 Our finding concurs with the previous studies that mortality rate in HCV/HIV co-infected patients was significantly higher than HIV/HBV co-infected patients. 38,39 Second, a common side-effect of NNRTI drugs is liver toxicity which is associated with the hepatotoxicity rate especially in patients with prior liver disease. 40,41 A previous study showed that NVP leads to the serious liver damage and druginduced liver fibrosis especially in patients with hepatitis C. [42][43][44] Third, the characteristics of the susceptible population who are likely to be co-infected HCV also contribute to increasing mortality risk and hepatotoxicity risk.…”

Section: Association Between Hepatotoxicity and Hepatitis Co-infectmentioning

confidence: 99%

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

Fairley

Sasadeusz

et al. 2017

Journal of Medical Virology

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Co-infection with hepatitis B (HBV) and C (HCV) is common among people living with HIV (PLHIV). This study investigates the impacts of hepatitis co-infection on antiretroviral therapy (ART) outcomes and hepatotoxicity in PLHIV. The cohort study included 1984 PLHIV. Hepatotoxicity was defined by elevated alanine aminotransferase (ALT) levels. ART outcomes were measured by CD4 cell counts, viral load, and mortality rate in patients. Among 1984 PLHIV, 184 (9.3%) were co-infected with HBV and 198 (10.0%) with HCV and 54 (2.7%) were co-infected with HBV and HCV. Of these patients, 156 (7.9%) had ALT elevation ≥ grade 1 at baseline. During the course of ART, the mortality rate and its adjusted hazard ratio (AHR) in PLHIV who were co-infected with HCV (2.6/100 person-years [py], AHR = 2.3, 95%CI 1.1-4.7) was higher than for patients with mono-infected HIV, as it was for those with an elevated ALT (4.4/100 py, AHR = 3.8, [1.7-8.2]) at baseline compared to those with normal ALT. After 6-12 months of ART, the incidence of hepatotoxicity among all the patients was 3.7/100 py. The risk of hepatotoxicity was higher in HCV co-infected (18.6/100 py, adjusted odds ratio [AOR] = 12.4, [8.1-18.2]) than HIV mono-infected patients, and for all regimens (nevirapine: 30.0/100 py, 34.2, 7.3-47.9; zidovudine/stavudine: 24.7/100 py, 22.1, 7.1-25.5; efavirenz: 14.5/100 py, 9.4, 3.5-19.2; lopinavir/ritonavir: 40.1/100 py, 52.2, 9.5-88.2) except tenofovir (4.3/100 py, 4.9, 0.8-9.5). Patients with HBV/HCV co-infected had high hepatotoxicity (10.0/100 py, 6.3, 1.2-23.3) over the same period. Patients with HCV co-infection and HBV/HCV co-infection demonstrated higher hepatotoxicity rate compared with HIV mono-infected patients in China.

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“…[9][10][11][12] Advanced liver disease accounted for 13% of all deaths among PLWH prior to treatment with direct-acting antivirals (DAAs), and in the US chronic HCV infection has been shown to be the leading cause of liver disease and related mortality in coinfected individuals. [13][14][15][16][17] In the past, persons with HIV/HCV coinfection achieved lower rates of sustained virologic response (SVR) after use of interferon and ribavirin HCV treatment compared with those with HCV mono-infection. [5] In addition to poor efficacy, older HCV treatment regimens were associated with many adverse effects such as depression, anemia, flu-like symptoms, and were often contraindicated due to additional comorbidities within the PLWH.…”

Section: Introductionmentioning

confidence: 99%

Real-world efficacy of direct acting antiviral therapies in patients with HIV/HCV

et al. 2020

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The advent of direct-acting antiviral (DAA) therapies has dramatically transformed HCV treatment, with most recent trials demonstrating high efficacy rates (>90%) across all genotypes and special populations, including patients with HIV/HCV coinfection. The efficacy rates of HCV treatment are nearly identical between patients with HCV monofection and patients with HIV/HCV coinfection; however, there are limited studies to compare real-world efficacy with efficacy observed in clinical trials. Using a database from HIV clinics across the United States (US), we identified 432 patients with HIV/HCV coinfection who completed DAA therapy from January 1, 2014 to March 31, 2017 and were assessed for efficacy. Efficacy was evaluated as sustained virologic response (SVR) 12 weeks after DAA completion; furthermore, factors associated with achieving SVR12 were identified. In this analysis, we found DAA therapies to be effective, with 94% of the patients achieving SVR12 and 6% experiencing virologic failure. Baseline variables, including older age, HCV viral load <800K IU/ML, FIB-4 score <1.45, absence of depression, diabetes, substance abuse, and use of DAA regimens without ribavirin were significant predictors of achieving SVR12. Patients with fewer comorbidities, better liver health, and lower HCV viral loads at baseline were more likely to achieve treatment success. Our results were consistent with other real-world studies, supporting the use of HCV therapy in HIV/HCV coinfected patients.

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Liver‐related mortality and hospitalizations attributable to chronic hepatitis C virus coinfection in persons living with HIV

Cited by 14 publications

References 11 publications

Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project

Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

Real-world efficacy of direct acting antiviral therapies in patients with HIV/HCV

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