Clinical outcomes and prognostic factors after HCV clearance with DAA in HIV/HCV-coinfected patients with advanced fibrosis/cirrhosis

Abstract

Aims and Background. We assessed long-term clinical outcomes and prognostic factors for liver disease progression after sustained viral response (SVR) with direct-acting antivirals (DAAs) in HIV/HCV coinfected patients with advanced fibrosis (AdF) or cirrhosis. Approach and Results. A total of 1,300 patients who achieved SVR with DAAs from 2014 to 2017 in Spain were included: 1145 with chronically advanced liver disease (cACLD) (384 AdF and 761 compensated cirrhosis [CoC]) and 155 with decompensated cirrhosis (DeC). The median follow-up was 40.9 months. Overall, 85 deaths occurred, 61 due to non-liver non-AIDS-related (NLNA) causes that were the leading cause of death across all stages of liver disease. The incidence (95% confidence interval [CI]) of decompensation per 100 person-years (py) was 0 in patients with AdF, 1.01 (0.68–1.51) in patients with CoC, and 8.35 (6.05–11.53) in patients with DeC. The incidence (95% CI) of hepatocellular carcinoma (HCC) per 100 py was 0.34 (0.13–0.91) in patients AdF, 0.73 (0.45–1.18) in patients with CoC, and 1.92 (1.00–3.70) per 100 py in patients with DeC. Prognostic factors for decompensation in patients with cACLD included serum albumin, liver stiffness measurement (LSM), and FIB-4. In this population, LSM and LSM-based posttreatment risk stratification models showed their predictive ability for decompensation and HCC. Conclusions. NLNA events were the leading causes of morbidity and mortality after DAA cure among coinfected patients with AdF/cirrhosis. Among those with cACLD, baseline LSM and posttreatment LSM-based models helped to assess decompensation and HCC risk.