A changing paradigm: management and treatment of the HCV/HIV-co-infected patient

Abutaleb, Ameer; Sherman, Kenneth E.

doi:10.1007/s12072-018-9896-4

Cited by 20 publications

(23 citation statements)

References 71 publications

(86 reference statements)

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“…It is estimated that 2.27 to 2.75 million people around the world have hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection. [1][2][3] In the United States (US), of the people living with HIV (PLWH), about 25% are estimated to have HCV infection, which consequently triples the risk for liver disease, liver failure, and liver related death. [4] Nearly 75% to 82% of PLWH who inject drugs are also infected with HCV.…”

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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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…We also found that higher values of plasma biomarkers (IP-10, IL-8, IL-6, OPG, sVCAM-1, sICAM-1, and D-dimer) were related to higher values of liver disease severity (CTP), but only IP-10 and IL-6 had high accuracy in separating patients with Child-Pugh B cirrhosis (CTP 7-9). www.nature.com/scientificreports www.nature.com/scientificreports/ HIV/HCV-coinfected patients usually have a faster progression of chronic hepatitis C 28 and higher levels of plasma biomarkers of bacterial translocation, immune activation, inflammation, and coagulation, despite suppressive ART 29 . In our study, plasma values of biomarkers were very similar in HIV/HCV-coinfected and HCV-monoinfected patients with advanced HCV-related cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Plasma IP-10 and IL-6 are linked to Child-Pugh B cirrhosis in patients with advanced HCV-related cirrhosis: a cross-sectional study

Salgüero

Medrano

González-García

et al. 2020

Sci Rep

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We aimed to evaluate the association of plasma biomarkers linked to inflammation (bacterial translocation, inflammatory response, and endothelial dysfunction), coagulopathy, and angiogenesis with the severity of liver cirrhosis (assessed by the Child-Pugh-Turcotte score, CTP) and Child-Pugh B cirrhosis (CTP 7-9) in patients with advanced hepatitis C virus (HCV)-related cirrhosis. We carried out a cross-sectional study in 97 patients with advanced HCV-related cirrhosis (32 HCV-monoinfected and 65 HIV/HCV-coinfected). Plasma biomarkers were measured by ProcartaPlex multiplex immunoassays. The outcome variable was the CTP score and the Child-Pugh B cirrhosis (CTP 7-9). HIV/HCV-coinfected patients and HCV-monoinfected patients with advanced HCV-related cirrhosis had near-equivalent values of plasma biomarkers. Higher values of plasma biomarkers linked to an inflammatory response (IP-10, IL-8, IL-6, and OPG), endothelial dysfunction (sVCAM-1 and sICAM-1), and coagulopathy (D-dimer) were related to higher CTP values. The most significant biomarkers to detect the presence of Child-Pugh B cirrhosis (CTP 7-9) were IP-10 (p-value= 0.008) and IL-6 (p-value=0.002). The AUC-ROC values of IP-10, IL-6, and both biomarkers combined (IP-10+IL-6) were 0.78, 0.88, and 0.96, respectively. In conclusion, HIV infection does not appear to have a significant impact on the analyzed plasma biomarkers in patients with advanced HCV-related cirrhosis. However, plasma biomarkers linked to inflammation (inflammatory response and endothelial dysfunction) were related to the severity of liver cirrhosis (CTP score), mainly IP-10 and IL-6, which discriminated patients with Child-Pugh B concerning Child-Pugh A. The hepatitis C virus (HCV) has a prevalence of active infection of around 1% worldwide (71 million people) 1. HCV-infected patients progress slowly during decades (10 to 20 years), developing liver fibrosis and cirrhosis, which can evolve into decompensated cirrhosis and hepatocellular carcinoma 2. Chronic hepatitis C causes chronic liver inflammation that accelerates the development of cirrhosis and other comorbidities 3,4. The cirrhosis-associated immune dysfunction (CAID) is a pathophysiological process that appears in cirrhosis and is enhanced in advanced cirrhosis. The CAID is characterized by higher levels of inflammation, immune activation, and deregulation of the immune system, which are related to the progression to hepatic decompensation 5,6. Patients with hepatic decompensation (Child-Turcotte-Pugh, CTP class B or C) could develop complications

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“…Therefore, HIV infection only showed a slight impact on the outcome measures in our cohort of patients with advanced HCV-related cirrhosis, both at baseline and during follow-up after HCV eradication with AAD. This fact is remarkable because HIV infection promotes a faster progression of chronic hepatitis C [22] and higher plasma levels of markers linked to bacterial translocation, immune activation, in ammation and coagulation, despite suppressive ART [24]. It is probable that the absence of relevant differences between groups may be due to the fact that all of our patients had advanced stages of cirrhosis, where CAID is usually found, characterized by elevated immune activation, in ammation, and dysregulation of the immune system [4].…”

Section: Discussionmentioning

confidence: 99%

“…In HIV/HCV-coinfected patients, HIV infection increases a series of negative factors such as HCV replication, HCV-induced hepatic in ammation, hepatocyte apoptosis, and microbial translocation, while it also leads to a deterioration of the speci c immune responses against HCV [23,24]. Antiretroviral therapy (ART) delays the progression of brosis and reduces clinical complications among HIV/HCV-coinfected patients, but despite suppressive ART, these patients still have abnormally high levels of plasma biomarkers related to bacterial translocation, immune activation, in ammation and coagulation [24], which are related to higher morbidity and mortality [25]. Similarly, DAA treatments against HCV infection also achieve elevated SVR rates [26,27] and delay CHC progression in HIV/HCVcoinfected patients [28,29].…”

Section: Introductionmentioning

confidence: 99%

Improvement of liver disease and inflammation in patients with advanced HCV-related cirrhosis after antiviral therapy

Medrano

Berenguer

Salgüero

et al. 2020

Preprint

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Eradication of hepatitis C virus (HCV) promotes an improvement in liver disease and deactivation of the immune system. Here, we aimed to evaluate the changes in liver disease scores and plasma biomarkers following HCV clearance with direct-acting antivirals (DAAs) in patients with advanced HCV-related cirrhosis. We performed a prospective study of patients with advanced cirrhosis (liver decompensation or liver stiffness measurement [LSM]≥25 kPa or hepatic liver pressure gradient [HVPG]≥10 mmHg or Child-Pugh-Turcotte (CTP)≥7) who received DAA therapy. Variables were assessed at baseline and 48 weeks after HCV treatment completion. Statistical analyses were performed employing Generalized Linear Mixed Models (GLMM). In this study, 62 patients (12 HCV-monoinfected and 50 HIV/HCV-coinfected) who achieved SVR were included in the analysis. We found significant decreases in LSM, HVPG, LBP, IP-10, IL-8, IL-1β, IL-18, IL-1RA, OPG, sVCAM-1, sICAM-1, TNFR-I, PAI-1, and VEF-A during follow-up. Variations in most outcome measures were similar as for HCV-monoinfected and HIV/HCV-coinfected patients. We found significant positive associations between changes in LBP, IP-10, MCP-1, IL-8, IL-1β, IL-18, IL-6, OPG, sVCAM-1, sICAM-1, and PAI-1 and LSM values after HCV clearance. We found variations in LBP, IL-8, IL-6, IL-18, OPG, PAI-1, and D-dimer were positively associated with changes in HVPG values; and variations in IP-10, IL-1β, IL-6, TNF-α, IL-1RA, OPG, and sICAM-1 were related to changes in CTP score. In conclusion, the eradication of HCV with all-oral DAAs promoted a decrease in the severity of advanced cirrhosis and plasma biomarkers (inflammation, coagulopathy, and angiogenesis), which were positively associated with each other.

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A changing paradigm: management and treatment of the HCV/HIV-co-infected patient

Cited by 20 publications

References 71 publications

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

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

Plasma IP-10 and IL-6 are linked to Child-Pugh B cirrhosis in patients with advanced HCV-related cirrhosis: a cross-sectional study

Improvement of liver disease and inflammation in patients with advanced HCV-related cirrhosis after antiviral therapy

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