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

Abstract

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.

Five-Year Follow-Up of Cured HCV Patients under Real-World Interferon-Free Therapy

“…Conversely, the patients with liver cirrhosis constituting the majority in the analyzed population are considered to be the most at risk of serious liver complications such as hepatic decompensation in the form of ascites and encephalopathy, the upper gastrointestinal bleeding as a consequence of portal hypertension, and hepatocellular carcinoma. We have shown that the overall and annual prevalence of these severe medical events was lower from the third year of follow-up than during the first 2 years, which means less risk of complications over time, and our findings supported the results of other studies [19][20][21][22][23][24][25]. However, none of these studies covered such a long period of 5 years follow-up.…”

Racial Disparity in HCV Demographics and Treatment Between Interferon Era (2002–2003) and Direct Acting Anti-viral Era (2019)

“…The continued appearance of older patients in the clinic also argues for an increase in efforts to target treatment and follow-up efforts since they may represent a cohort with the gradual evolution of the liver disease and at significant risk. This is especially important given the solid evidence that even patients with advanced liver disease benefit from treatment with respect to the progression of the disease [14][15][16][17].…”

Plant-made vaccines against viral diseases in humans and farm animals

“…The recent development of orally administered antivirals that are able to cure the HCV infection in more than 90% of treated patients represents a significant breakthrough in HCV therapy. However, most patients in low/medium-income countries have little access to diagnosis and treatment ( Quaranta et al, 2021 ). Prevention of the viral infection remains the most efficient way to reduce HBV/HCV-related morbidity and mortality.…”