Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER cohort

Quaranta, Maria Giovanna; Ferrigno, Luigina; Monti, Monica; Filomia, Roberto; Biliotti, Elisa; Iannone, Andrea; Migliorino, Guglielmo Marco; Coco, B.; Morisco, Filomena; Vinci, M.; D’Ambrosio, Roberta; Chemello, Liliana; Massari, Marco; Ieluzzi, Donatella; Russo, Francesco Paolo; Blanc, Pierluigi; Verucchi, Gabriella; Puoti, Massimo; Rumi, Maria Grazia; Barbaro, Francesco; Santantonio, T.; Federico, Alessandro Di; Chessa, Luchino; Gentile, Ivan; Zuin, Massimo; Parruti, Giustino; Morsica, Giulia; Kondili, Loreta A.

doi:10.1007/s12072-020-10034-0

Cited by 11 publications

(14 citation statements)

References 28 publications

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“…Regarding the HCC occurrence, a similar cumulative HCC incidence in coinfected (2.2%) and monoinfected (3.9%) (p=0.38) patients after viral eradication, was reported in our recent study, suggesting that HIV coinfection is not associated with a higher probability of developing liver complications in successfully DAA treated patients with compensated cirrhosis [3].…”

Section: Discussionsupporting

confidence: 87%

“…Sustained virologic response (SVR) reduces the risk of liver decompensation and of hepatocellular carcinoma (HCC) and improves survival [ 1 , 4 , 5 ]. However, a “point of non-return” in terms of deterioration of liver function, has been observed in part of patients regardless of viral eradication, potentially due to the pre-treatment severe liver fibrosis and/or presence of other cofactors of liver disease progression [ 3 , 4 , 6 ]. As a cofactor, Human Immunodeficiency Virus (HIV) coinfection negatively affect the natural course of chronic HCV infection.…”

Section: Introductionmentioning

confidence: 99%

“…Keywords: Hepatitis C virus, Human immunodeficiency virus, Real-life cohort, Direct-acting antivirals, Advanced liver disease, Decompensated cirrhosis Background Hepatitis C Virus (HCV) eradication by direct-acting antivirals (DAA) is linked to improved outcomes at all stages of liver disease [1]. Available data suggest that the maximum efficacy and benefits are obtained by treating patients before they reach the stage of advanced fibrosis or cirrhosis [2,3]. Sustained virologic response (SVR) reduces the risk of liver decompensation and of hepatocellular carcinoma (HCC) and improves survival [1,4,5].…”

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confidence: 99%

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Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort

et al. 2021

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Background The development of direct-acting antivirals (DAA) for HCV has revolutionized the treatment of HCV, including its treatment in patients with HIV coinfection. The aim of this study was to compare the changes in liver function between coinfected and monoinfected patients with cirrhosis who achieved HCV eradication by DAA. Methods Patients with pre-treatment diagnosis of HCV liver cirrhosis, consecutively enrolled in the multicenter PITER cohort, who achieved a sustained virological response 12 weeks after treatment cessation (SVR12) were analysed. Changes in Child-Pugh (C-P) class and the occurrence of a decompensating event was prospectively evaluated after the end of DAA treatment. Cox regression analysis was used to evaluate factors independently associated with changes in liver function following viral eradication. Results We evaluated 1350 patients, of whom 1242 HCV monoinfected (median follow-up 24.7, range 6.8–47.5 months after viral eradication) and 108 (8%) HCV/HIV coinfected (median follow-up 27.1, range 6.0–44.6). After adjusting for age, sex, HCV-genotype, HBsAg positivity and alcohol use, HIV was independently associated with a more advanced liver disease before treatment (C-P class B/C vs A) (OR: 3.73, 95% CI:2.00–6.98). Following HCV eradication, C-P class improved in 17/20 (85%) coinfected patients (from B to A and from C to B) and in 53/82 (64.6%) monoinfected patients (from B to A) (p = 0.08). C-P class worsened in 3/56 coinfected (5.3%) (from A to B) and in 84/1024 (8.2%) monoinfected patients (p = 0.45) (from A to B or C and from B to C). Baseline factors independently associated with C-P class worsening were male sex (HR = 2.00; 95% CI = 1.18–3.36), platelet count < 100,000/μl (HR = 1.75; 95% CI 1.08–2.85) and increased INR (HR = 2.41; 95% CI 1.51–3.84). Following viral eradication, in 7 of 15 coinfected (46.6%) and in 61 of 133 (45.8%) monoinfected patients with previous history of decompensation, a new decompensating event occurred. A first decompensating event was recorded in 4 of 93 (4.3%) coinfected and in 53 of 1109 (4.8%) monoinfected patients (p = 0.83). Conclusions Improvement of liver function was observed following HCV eradication in the majority of patients with cirrhosis; however viral eradication did not always mean cure of liver disease in both monoinfected and coinfected patients with advanced liver disease.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort

et al. 2021

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“…We found that the overall SVR12 rate (93.9% and 94.1% in coinfected and monoinfected patients, respectively) is similar to those reported in clinical trials and in our previous study (18), con rming the high e cacy of DAA therapy in the real-world setting also in patients with advanced liver disease, regardless of HIV coinfection (18)(19)(20)(21). The results of this medium-term study con rm that HCV clearance obtained by DAA is feasibly linked to an improved outcome in patients with advanced liver disease, independently by HIV-coinfection.…”

Section: Discussionsupporting

confidence: 90%

Liver Function Following Hepatitis C Virus Eradication by Direct Acting Antivirals in Patients With Liver Cirrhosis: Data from The PITER Cohort

Quaranta

Ferrigno

Tata³

et al. 2021

Preprint

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Background: The development of direct-acting antivirals (DAA) for HCV has revolutionized the treatment of HCV, including its treatment in patients with HIV coinfection. The aim of this study was to compare the changes in liver function between coinfected and monoinfected patients with cirrhosis who achieved HCV eradication by DAA in the multicenter PITER cohort.Methods: Patients with pre-treatment diagnosis of HCV liver cirrhosis, consecutively enrolled in PITER, who achieved a sustained virological response (SVR12) and with an available follow-up after DAA treatment, were analysed. Liver function was prospectively evaluated as changes in Child-Pugh (C-P) class during patient’s follow-up after the end of DAA treatment. Cox regression analysis was used to evaluate factors independently associated with changes in liver function following viral eradication.Results: We evaluated 1350 successfully DAA treated patients with cirrhosis, of whom 1242 HCV monoinfected (median follow-up of 24.7, range 6.8-47.5 months after viral eradication) and 108 (8%) HCV/HIV coinfected (median follow-up of 27.1, range 6-44.6 months after viral eradication). Despite the significant younger age (p<0.001), coinfected patients had higher liver disease severity in terms of C-P class score (p<0.001). Following HCV eradication, C-P class improved in 17/20 coinfected (85%) and in 53/82 (64.6%) monoinfected patients with a pre-treatment C-P class B or C (p>0.05). C-P class worsened in 3/56 coinfected (5.3%) and in 84/1024 (8.2%) monoinfected patients with pre-treatment C-P class A or B (p>0.05). Factors independently associated with C-P class deterioration were male sex (HR=2.01; 95% CI=1.19-3.40), platelet count <100,000/µl (HR=1.88; 95% CI 1.17-3.03) and higher pretreatment INR value (HR=2.34; 95% CI 1.47-3.71). Following viral eradication, in 7 of 15 coinfected (47%) and in 61 of 133 (45.6%) monoinfected patients with previous history of decompensation a new decompensating event occurred. An incident decompensating event was recorded in 4 of 93 (4.3%) coinfected and in 53 of 1109 (4.8%) monoinfected patients. Conclusions: Improvement of liver function is observed following HCV eradication in the majority of patients with cirrhosis; however viral eradication does not always mean cure of liver disease in both monoinfected and coinfected patients with advanced liver disease.

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“…In individuals with compensated cirrhosis, HIV coinfection was not related with an increased probability of liver complications after viral eradication than those HCV-monoinfected[ 93 , 94 ]. In the series of Corma-Gómez et al [ 95 ], the likelihood of staying free of hepatic complications or transplant at 12 and 24 mo was 99% and 96% in HCV-monoinfected patients and 99 and 98% in HIV/HCV coinfected patients with predominantly (> 95% of individuals) Child-Pugh class A cirrhosis ( P = 0.648).…”

Section: Effects Of Svrmentioning

confidence: 99%

Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response

Cuesta¹,

Márquez-Coello²,

Illanes-Álvarez³

et al. 2022

WJH

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Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.

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Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER cohort

Cited by 11 publications

References 28 publications

Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort

Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort

Liver Function Following Hepatitis C Virus Eradication by Direct Acting Antivirals in Patients With Liver Cirrhosis: Data from The PITER Cohort

Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response

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