Low risk of liver decompensation among human immunodeficiency virus/hepatitis C virus–coinfected patients with mild fibrosis in the short term

Macı́as, Juan; Mancebo, M.J.; Márquez, Manuel; Merino, Dolores; Téllez, Francisco; Rivero, Antonio; Wichmann, Miguel Ángel von; López‐Cortés, Luis F.; Merchante, Nicolás; Santos, Jesús; Raffo, Miguel; Pérez-Pérez, Montserrat; Camacho, Ángela; Iribarren, José Antonio; Pineda, Juan A.

doi:10.1002/hep.27674

Cited by 15 publications

(7 citation statements)

References 20 publications

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“…Our findings are similar to a previous study by Merchante and colleagues where patients with cirrhosis had an incidence of hepatic decompensation of 46 per 1000 PY [32]. Similarly, Macías et al reported that patients with LSM <14.6 kPa have a lower risk of decompensation [35]. However, these studies did not differentiate between patients with and without clinical evidence of liver cirrhosis.…”

Section: Discussionsupporting

confidence: 89%

Liver-related Events in Human Immunodeficiency Virus–infected Persons With Occult Cirrhosis

Benmassaoud

Nitulescu

Pembroke

et al. 2018

Clinical Infectious Diseases

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Background Human immunodeficiency virus (HIV)–infected patients are at increased risk of liver-related mortality. The effect of occult cirrhosis (OcC), defined as preclinical compensated cirrhosis without any clinical findings, on liver-related events is unknown. Methods HIV-infected patients from 2 Canadian cohorts underwent transient elastography (TE) examination and were classified as (1) OcC (TE ≥13 kPa with no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); (2) overt cirrhosis (OvC) (TE ≥13 kPa with signs of cirrhosis); or (3) noncirrhotic patients (TE <13 kPa). Incidence and risk factors of liver-related events were investigated through Kaplan-Meier and Cox regression analyses, respectively. We estimated monitoring rates according to screening guidelines for hepatocellular carcinoma (HCC) by OcC and OvC status. Results A total of 1092 HIV-infected patients (51% coinfected with hepatitis C virus) were included. Prevalence of OcC and OvC at baseline was 2.7% and 10.7%, respectively. During a median follow-up of 1.8 (interquartile range, 1.5–2.8) years, the incidence of liver-related events in noncirrhosis, OcC, and OvC was 3.4 (95% confidence interval [CI], 1.2–7.3), 34.0 (95% CI, 6.0–104.0), and 37.0 (95% CI, 17.0–69.1) per 1000 person-years, respectively. Baseline OcC (adjusted hazard ratio [aHR], 7.1 [95% CI, 1.3–38.0]) and OvC (aHR, 8.5 [95% CI, 2.8–26.0]) were independently associated with liver-related events. Monitoring rates for HCC were lower in patients with OcC (24%) compared to those with OvC (40%). Conclusions HIV-infected patients with OcC have a high incidence of liver-related events. Greater surveillance and earlier recognition with appropriate screening strategies are necessary for improved outcomes.

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Section: Discussionsupporting

confidence: 89%

Liver-related Events in Human Immunodeficiency Virus–infected Persons With Occult Cirrhosis

Benmassaoud

Nitulescu

Pembroke

et al. 2018

Clinical Infectious Diseases

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“…These results are a proof of concept, and more studies are needed to precisely determine the value of the information obtained by repeated measurements, especially for survival without liver complications, and to identify the risk of ascites, encephalopathy, variceal bleeding or HCC. The aim of one recent study was to evaluatethe risk of decompensation and death in human immunodeficiency virus (HIV)/HCV‐co‐infected individuals according to baseline fibrosis determined by either liver biopsy or LSM . Patients with HIV/HCV co‐infection who were treatment‐naive or who had not achieved a SVR to HCV therapy were included in this cohort.…”

Section: The Short‐term Prognosis Of Patients With Mild Disease Is Exmentioning

confidence: 99%

“…The adjusted hazard ratio for patients with LSM and the 95% CI for death by LSM were as follows: 6-9.4 kPa, 1.7 (0.63-4.79), P = 0.288; 9.5-14.5 kPa, 3.38 (1.2-9.5), P = 0.021; ≥14.6 kPa, 12.7 (4.9-33.6), P < 0.0001. The adjusted subhazard ratio for patients with LSM and the 95% CI by LSM category were as follows: 6-9.4 kPa, 1.89 (0.18-20.3), P = 0.599; 9.5-14.5 kPa, 6.59 (0.73-59.2), P = 0.092; ≥14.6 kPa, 59.5 (8.3-427), P < 0.0001 (13). In summary, patients co-infected with HIV/HCV without advanced fibrosis are at a very low risk of shortterm decompensation or death suggesting that deferring HCV therapy for a few years and monitoring the progression of fibrosis is a safe option.…”

mentioning

confidence: 92%

Why I do not treat patients for mild disease

Hézode

2016

Liver International

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The short-term prognosis of patients with chronic hepatitis C and mild disease is excellent. Monitoring of the progression of fibrosis is easy to perform with non-invasive tests. Current all-oral interferon (IFN)-and ribavirin (RBV)-free regimens offer sustained viral response (SVR) rates of more than 90% as well as 12-weeks of treatment for most patients with mild disease. Several DAA combinations can be selected to optimize efficacy and safety outcomes. A short treatment duration of 8 weeks could be indicated in most patients with mild disease. However, additional data from clinical trials and real-life experience are needed to confirm this option. Moreover, current regimens are not cost-effective for patients with mild disease. In practice, deferral of HCV treatment for a few years and monitoring the progression of fibrosis is a safe option until cheaper, shorter, more effective and more convenient HCV regimens become available.

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“…As patients with advanced liver disease are at considerable risk for hepatic decompensation and death [22], they represent the frontline in the use of IFN-free regimens. Combining treatmentnaïve and treatment-experienced patients receiving 12 weeks of SOF/DCV in the ALLY-2 study, the SVR rate among patients with advanced liver fibrosis treated for 12 weeks was 97%.…”

Section: Discussionmentioning

confidence: 99%

“…[15]. However, as patients with advanced liver disease are at considerable risk for hepatic decompensation and death [22], they have an urgent need for effective treatment options.…”

Section: Introductionmentioning

confidence: 99%

Interferon-free treatment with sofosbuvir/daclatasvir achieves sustained virologic response in 100% of HIV/HCV-coinfected patients with advanced liver disease

et al. 2016

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Conflicts of interest: M.M. received honoraria for consulting from Janssen, payments for lectures from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen, and Roche, as well as travel support from AbbVie, Gilead, MSD, and Roche. P.S. received payments for lectures from Roche and travel support from AbbVie, Gilead, Janssen, and Roche. S.S. has nothing to disclose. B.S. has nothing to disclose. D.C. has nothing to disclose. T.B. received payments for lectures from Roche and travel support from Bristol-Myers Squibb. A.F.S. received honoraria for consulting from Gilead, payments for lectures from Boehringer Ingelheim, Janssen, and Roche, as well as travel support from Bristol-Myers Squibb, Gilead, Janssen, and Roche.

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Low risk of liver decompensation among human immunodeficiency virus/hepatitis C virus–coinfected patients with mild fibrosis in the short term

Cited by 15 publications

References 20 publications

Liver-related Events in Human Immunodeficiency Virus–infected Persons With Occult Cirrhosis

Liver-related Events in Human Immunodeficiency Virus–infected Persons With Occult Cirrhosis

Why I do not treat patients for mild disease

Interferon-free treatment with sofosbuvir/daclatasvir achieves sustained virologic response in 100% of HIV/HCV-coinfected patients with advanced liver disease

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