Liver stiffness reduction and serum fibrosis score improvement in <scp>HIV</scp>/hepatitis C virus‐coinfected patients treated with direct‐acting antivirals

Fabbri, Gioele; Mastrorosa, Ilaria; Vergori, Alessandra; Timelli, Laura; Lorenzini, Patrizia; Zaccarelli, Mauro; Cicalini, Stefania; Bellagamba, Rita; Plazzi, MM; Mazzotta, Valentina; Antinori, Andrea; Ammassari, Adriana

doi:10.1111/hiv.12632

Cited by 19 publications

(16 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All HIV/HCV coinfected patients achieved SVR at 12 weeks after end of treatment. At this point, liver enzymes returned to normal levels (in all patients in whom levels of liver enzymes were increased at baseline], and the values of the APRI score and the FIB-4 index significantly diminished, in agreement with previous studies [ 41 , 42 ], suggesting a rapid improvement in hepatic injury after HCV eradication. We also observed a reduction of liver stiffness (LS] and all patients presented values < 7.1 KPa after a mean period of 25 months after treatment initiation.…”

Section: Discussionsupporting

confidence: 89%

“…Thus, we could not verify if this decrease in LS values paralleled the rapid decrease of liver enzymes, which would support the link between LS and liver enzymes. Interestingly, other authors have found significant decreases of LS early after HCV eradication with DAAs therapy (12 weeks after end of treatment], in parallel with the normalization of liver enzymes [ 41 , 42 ], which supports an influence of necroinflammatory activity on LS values [ 40 ]. An interesting finding in our study was the significant increase in CD4 counts after HCV eradication in a relatively short period of only 12 weeks after the end of treatment, which supports a negative impact of HCV on immune restoration in HIV patients on ART, as has been previously suggested [ 43 ].…”

Section: Discussionmentioning

confidence: 78%

See 1 more Smart Citation

Liver Stiffness Hinders Normalization of Systemic Inflammation and Endothelial Activation after Hepatitis C Virus (HCV) Eradication in HIV/HCV Coinfected Patients

et al. 2020

View full text Add to dashboard Cite

Systemic inflammation, endothelial dysfunction and coagulopathy are of high clinical relevance in the management of people living with HIV (PLWH), and even more in patients coinfected with hepatitis C virus (HCV). It has been suggested a significant impact of HCV coinfection on these conditions. However, HCV can be eradicated in most patients with the new direct-acting antivirals (DAAs) therapy. We have analyzed the effect of HCV on systemic inflammation, endothelial activation and coagulopathy in PLWH and its evolution after HCV eradication with DAAs. Twenty-five HIV/HCV coinfected (HIV/HCV group), 25 HIV monoinfected (HIV group) and 20 healthy controls (HC) were included in the study. All patients were on ART and HIV suppressed. Levels of fourteen markers of systemic inflammation, endothelial activation and coagulopathy (IL-1ß, IL-6, IL-12p70, IL-8, TNFα, D-dimer, Eotaxin, IL-18, IP-10, monocyte chemotactic protein-1 (MCP-1), plasminogen activator inhibitor-1 (PAI-1), TNFα receptor 1 (TNFR1), vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1)) were measured on plasma at baseline and after DAAs-mediated HCV eradication. Non-parametric tests were used to establish inter/intra-group differences. At baseline, the HIV/HCV group showed increased levels of IL-18 (p = 0.028), IP-10 (p < 0.0001), VCAM-1 (p < 0.0001) and ICAM-1 (p = 0.045), compared to the HC and HIV groups, with the highest levels for IL18 and IP10 observed in HIV/HCV patients with increased liver stiffness (≥7.1 KPa). Eradication of HCV with DAAs-based therapy restored some but not all the evaluated parameters. VCAM-1 remained significantly increased compared to HC (p = 0.001), regardless of the level of basal liver stiffness in the HIV/HCV group, and IP-10 remained significantly increased only in the HIV/HCV group, with increased level of basal liver stiffness compared to the HC and to the HIV groups (p = 0.006 and p = 0.049, respectively). These data indicate that DAAs therapy in HIV/HCV co-infected patients and HCV eradication does not always lead to the normalization of systemic inflammation and endothelial dysfunction conditions, especially in cases with increased liver stiffness.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 78%

Liver Stiffness Hinders Normalization of Systemic Inflammation and Endothelial Activation after Hepatitis C Virus (HCV) Eradication in HIV/HCV Coinfected Patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Liver biopsy, the gold standard for assessment of fibrosis and steatosis, has now been replaced by non-invasive methods such as the fibrosis 4 (FIB-4) index for liver fibrosis, the HSI, and VCTE [20][21][22]41]. In addition to biopsy and VCTE, the HSI was used to detect steatosis in this cohort because all of its components were collected as part of routine care.…”

Section: Discussionmentioning

confidence: 99%

“…Liver biopsy is the reference standard for diagnosing hepatic fibrosis and steatosis; however, it is invasive, expensive and affected by biopsy size (sampling error) and interobserver variation among pathologists [20]. Consequently, non-invasive serum-based tests and imaging techniques, such as vibration-controlled transient elastography (VCTE) to measure fibrosis with controlled attenuation parameter (CAP) measurement to assess hepatic steatosis, respectively, have replaced liver biopsy in most centers [21,22]. However, because VCTE with CAP may not be available in many clinical settings, other non-invasive serum-based assessments of steatosis, such as the hepatic steatosis index (HSI) have been developed [23,24] but not assessed in those with HIV.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence and Impact of Hepatic Steatosis on Response to Direct-Acting Antiviral Therapy in HIV–HCV Coinfection

Johnson

Sterling

2020

Biology

View full text Add to dashboard Cite

(1) Background: Direct-acting antiviral therapy for chronic hepatitis C virus (HCV) infection is associated with high sustained virologic response (SVR) and overcomes negative predictive factors, including steatosis, in patients without human immunodeficiency virus (HIV) coinfection. The impact of steatosis on SVR in patients with HIV–HCV coinfection is unknown. (2) Methods: A retrospective analysis of patients treated with direct-acting antivirals was performed. Demographic, laboratory and direct-acting antiviral regimen data were prospectively collected. Metabolic syndrome and its components—diabetes mellitus, hypertension, dyslipidemia and obesity—were assessed. Hepatic steatosis (≥5%) was defined by liver biopsy or controlled attenuation parameter (CAP) measurement during vibration-controlled transient elastography (VCTE). (3) Results: A total of 151 HIV–HCV-coinfected patients on combined antiretroviral therapy and direct-acting antiviral therapy were included in this analysis. Prevalence of steatosis by liver biopsy (n = 34) or CAP (≥263 db/m) during VCTE (n = 92) was 27% and was independently associated with obesity (OR 3.11; 95% CI 1.43–6.82; p = 0.004) and the metabolic syndrome (OR 1.08; 95% CI 1.01–0.15; p = 0.01). The overall SVR rate (n = 148) was 95% and was not impacted by the presence of steatosis (p = 0.42). (4) Conclusions: Hepatic steatosis is common in HIV–HCV coinfection, correlates with obesity and the metabolic syndrome and does not impact SVR.

show abstract

“…Patients with severe inflammation or liver steatosis at baseline have greater improvements in the APRI index compared to those with lower inflammation and no steatosis (19). In the study conducted by Fabbri et al, APRI decreased in hepatitis C/HIV co-infected patients who underwent treatment with DAAs from a median of 0.94 to 0.37 (20).…”

Section: Aprimentioning

confidence: 95%

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

Orășan¹,

Ciulei²,

Coste³

et al. 2019

JMMS

View full text Add to dashboard Cite

The second-generation of direct-acting antiviral agents are the current treatment for chronic viral hepatitis C infection. To evaluate the regression of liver fibrosis in patients receiving this therapy, liver biopsy remains the most accurate method, but the invasiveness of this procedure is its major drawback. Different non-invasive tests have been used to study changes in the stage of liver fibrosis in patients with chronic viral hepatitis treated with the second-generation of direct-acting antiviral agents: liver stiffness measurements (with transient elastography or acoustic radiation force impulse elastography) or different scores that use serum markers to calculate a fibrosis score. We prepared a literature review of the available data regarding the long-term evolution of liver fibrosis after the treatment with direct-acting antiviral agents for chronic viral hepatitis C. Keywords  chronic viral hepatitis C, direct-acting antiviral agents, liver fibrosis Highlights ✓ Transient elastography is the routine investigation for liver fibrosis monitoring in patients with chronic viral hepatitis C treated with direct acting antiviral agents. ✓ The APRI and FIB-4 scores registered the highest decrease between the baseline and the end of the treatment in patients with chronic viral hepatitis C treated with direct acting antiviral agents.

show abstract

Liver stiffness reduction and serum fibrosis score improvement in HIV/hepatitis C virus‐coinfected patients treated with direct‐acting antivirals

Abstract: A reduction in liver stiffness and an improvement in fibrosis scores were observed in HIV/HCV-coinfected patients soon after DAA treatment. The clinical implications of these observations need to be evaluated in larger populations with longer follow-up.

Cited by 19 publications

References 17 publications

Liver Stiffness Hinders Normalization of Systemic Inflammation and Endothelial Activation after Hepatitis C Virus (HCV) Eradication in HIV/HCV Coinfected Patients

Liver Stiffness Hinders Normalization of Systemic Inflammation and Endothelial Activation after Hepatitis C Virus (HCV) Eradication in HIV/HCV Coinfected Patients

The Prevalence and Impact of Hepatic Steatosis on Response to Direct-Acting Antiviral Therapy in HIV–HCV Coinfection

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

Contact Info

Product

Resources

About