Regression of liver fibrosis is progressive after sustained virological response to HCV therapy in patients with hepatitis C and HIV coinfection

Abstract

There are few data about the long-term histological outcome of HIV-/HCV-coinfected patients after therapy with interferon and ribavirin. We performed an observational study of 216 patients who received therapy against HCV and who had at least three successive transient elastographies (TE) during the follow-up. The primary endpoint was confirmed fibrosis regression, defined as a reduction of at least 1 point in Metavir fibrosis score, confirmed and without worsening in successive TE. At baseline, 23% had fibrosis stage 4 or cirrhosis. Overall, 82 (38%) achieved sustained virological response (SVR), without differences in baseline fibrosis or time of follow-up. Confirmed fibrosis regression was observed in 55% of patients, higher for SVR (71% vs 44%; P < 0.01), and the likelihood of achieving fibrosis regression at 3, 5 and 7 years was 0.17, 0.51 and 0.67, respectively, for SVR patients, in comparison with 0.02, 0.23 and 0.41 for no SVR patients (P < 0.01, log-rank test at any time point). Progressive regression, defined as continuous improvement in successive TE, was observed in 62% of patients with advanced liver fibrosis or cirrhosis who achieved SVR. In a Cox regression model, only SVR (HR, 4.01; 95% CI, 2.33-7.57; P < 0.01) and a younger age (HR, 1.14; 95% CI, 1.05-1.25; P < 0.01; per year) were associated with fibrosis regression. This study confirms that the rate of liver fibrosis regression increases during the follow-up after SVR to interferon therapy in HIV-/HCV-coinfected patients.

CD4 and CD4/CD8 ratio progression in HIV-HCV infected patients after achievement of SVR

“…This study aims at assessing the long-term impact of this regimen in terms of liver disease progression, immunological recovery and overall clinical improvement in a cohort of HIV-HCV co-infected patients after a median 8-year follow-up. First, as previously reported in both HCV mono-infected and HIV-HCV co-infected patients [19], our study confirms that the achievement of SVR is beneficial in terms of liver-related mortality and fibrosis regression. The effect of HCV clearance was evident when considering that six liver-related deaths were restricted to patients in the non-SVR group, while no liver-related clinically significant event was reported in the SVR-group.…”

WFUMB Guidelines and Recommendations for Clinical Use of Ultrasound Elastography: Part 3: Liver

“…Significant histologic improvements have been documented in studies of paired liver biopsies from patients with chronic hepatitis C who achieved sustained viral eradication (Poynard et al 2002;Shiratori et al 2000) and patients with chronic hepatitis B who received long-term antiviral therapy (Chang et al 2010;Hadziyannis et al 2006). Several studies reported a significant decrease in liver stiffness values, compared with baseline values, in patients with HCV who achieved sustained viral eradication (Fontana et al 2009;Hezode et al 2011;Martinez et al 2011b;Ogawa et al 2009;Vergniol et al 2009;Stasi et al 2013;Casado et al 2013), as well as in HBV-infected patients treated with nucleoside analog drugs (Enomoto et al 2010;Fung et al 2011b;Lim et al 2011;Ogawa et al 2011;Osakabe et al 2011;Wong et al 2011;Kim et al 2013;Kuo et al 2014).…”

Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

“…We, and others, have found an important rate of fibrosis regression (FR) during the follow-up in HIV-/HCV-coinfected patients obtaining SVR [7,14,15]. In hypothesis, FR after SVR should be associated with even a lower risk of hepatic complications, and a prolonged survival.…”