Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients

Abstract

SummaryBackground and aimHepatitis C virus (HCV) therapy should be considered without delay in all patients with significant (SIGFIB) or advanced liver fibrosis (ADVFIB). We aimed to investigate the rates of treatment initiation with interferon-free regimens within a screening program for SIGFIB/ADVFIB in human immunodeficiency virus/HCV coinfected patients (HIV/HCV).MethodsThe FIB-4 was calculated in all HIV/HCV from 2014–2016. HIV/HCV were counselled by the HIV clinic and referred to the Division of Gastroenterology and Hepatology for transient elastography (TE) and evaluation for HCV therapy. Patients were stratified by FIB-4 of </≥1.45 (established cut-off for ruling out ADVFIB) and SIGFIB/ADVFIB were defined by liver stiffness >7.1 kPa/>9.5 kPa, respectively.ResultsAmong 1348 HIV+ patients, 16% (210/1348) had detectable HCV-RNA. One hundred HIV/HCV had a FIB-4 ≥1.45. Among these, 57% (57/100) underwent TE. The majority of these patients had SIGFIB (75%; 43/57) or ADVFIB (37%; 21/57), however, interferon-free treatment was initiated in only 56% (24/43).In addition, fifty-two percent (57/110) of HIV/HCV with FIB-4 <1.45 underwent TE. Interestingly, 40% (23/57) and 18% (10/57) of these patients showed SIGFIB or even ADVFIB, respectively, and 78% (18/23) finally received interferon-free treatment. Overall, only 20% (42/210) of HIV/HCV received interferon-free treatment.ConclusionFIB-4 was not useful for ruling out SIGFIB/ADVFIB in our cohort of HIV/HCV. Treatment was initiated only in a small proportion (20%) of HIV/HCV during the first 2 years of interferon-free treatment availability, although the observed proportion of patients with SIGFIB (assessed by TE) was considerably higher (58%). Thus, it requires the ongoing combined efforts of both HIV and HCV specialists to increase treatment uptake rates in this special population.Electronic supplementary materialThe online version of this article (doi: 10.1007/s00508-017-1231-x) contains supplementary material, which is available to authorized users.

High efficacy of interferon‐free therapy for acute hepatitis C in HIV‐positive patients

“…Preferred criteria (Grade A, Level II) . 24 score was calculated as age (years) Â aspartate transaminase (IU/l) Â (platelet count (10 9 /l) Â alanine transaminase (IU/l) 1/2 ) -1 .…”

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

“…Liver cirrhosis is the clinical endpoint of CLD complicated by the development of hepatocellular carcinoma and portal hypertension [3,4]. Identification and evaluation of fibrosis is crucial in the assessment of CLD, as it serves as an important treatment indication in various clinical situations [5][6][7][8]. There is solid evidence supporting the fact that liver fibrosis is potentially reversible as long as a certain "point of no return" is not exceeded.…”

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

“…Figure 3A,B Figure 4A,B) Among the 208 patients that presented with HCV viraemia at BL, ALT was available in 192 (92.3%) ( Figure 4A). 36 In all, 24/185 (11.5%) patients with an available FIB4-Score showed a FIB4 >3.25, indicating advanced liver fibrosis at BL, while in 106 (51%), significant liver fibrosis was ruled out based on a FIB4-Score <1.45 ( Figure 4B)…”

“…Additional laboratory parameters, including aspartate aminotransferase, alanine aminotransferase (ALT), gamma‐glutamyl transferase, alkaline phosphatase, serum bilirubin, albumin, prothrombin time, international normalized ratio and platelet count were recorded at BL and FU. The fibrosis‐4 Score (FIB4‐Score) was calculated based on BL and FU parameters . For patients that had undergone a liver fibrosis evaluation by transient elastography (TE), results recorded.…”

“…• HCV treatment uptake needs to be improved in Viennese HIV+ patients in order to reach the World Health Organization goal of HCV elimination by 2030. and FU parameters. 36 For patients that had undergone a liver fibrosis evaluation by transient elastography (TE), results recorded. Essentially, the percentage of HIV+ patients tested for HCV was assessed and the prevalences and incidences of HCV infection as well as virological clearance were calculated.…”