Sustained virological response to interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with human immunodeficiency virus and hepatitis C virus

Berenguer, Juan; Álvarez‐Pellicer, Julio; Martín, Pilar Miralles; López‐Aldeguer, José; von-Wichmann, Miguel Ángel; Quereda, Carmen; Mallolas, Josép; Sanz, José; Tural, Cristina; Bellón, José María; González‐García, Juan

doi:10.1002/hep.23020

Cited by 279 publications

(191 citation statements)

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“…However, in the Cox regression model, we did not find any significant difference between patients who achieved an SVR and those who did not. Particularly, in contrast to the observations of other studies, the achievement of SVR following INF therapy was not significantly associated with a reduction in the risk of death [3,4]. Our results can be partly explained by the sample size of treated patients (20 % out of all enrolled patients) and different INF-based regimens (peg-IFN or standard thriceweekly INF plus RBV) that have been used in the 15-year period of enrolment in the cohort.…”

Section: Discussioncontrasting

confidence: 99%

“…HIV/hepatitis C virus (HCV)-coinfected patients have accelerated progression of HCV-related liver disease and increased mortality rate compared to HCV-or HIV-monoinfected patients. There is increasing evidence that the achievement of sustained virologic response (SVR) after pegylated interferon (peg-IFN) plus ribavirin (RBV) treatment reduces the incidence of hepatocellular carcinoma (HCC), liver decompensation, and overall mortality in HIV/HCV-coinfected patients [3][4][5][6]. Although HCV coinfection is associated with an increased risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and diabetes mellitus (DM) among HIV-infected patients, the impact of SVR on the risk of the development of extrahepatic complications has been little investigated [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Leone

Prosperi

Costarelli

et al. 2016

Eur J Clin Microbiol Infect Dis

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Data on the effects of sustained virologic response (SVR) to hepatitis C virus (HCV) therapy on the outcome of extrahepatic complications are scarce. We conducted this study to assess the impact of SVR on the occurrence of chronic kidney disease (CKD), diabetes mellitus (DM), and cardiovascular disease (CVD) in a cohort of human immunodeficiency virus (HIV)-infected patients. We analyzed coinfected HIV/HCV patients in the Management of Standardized Evaluation of Retroviral HIV Infection (MASTER) cohort. Only event-free patients with a serum HCV-RNA determination at baseline were included. Patients were divided into four groups: INFexposed with SVR; INF-exposed without SVR; spontaneous HCV clearance; untreated viremic patients. We estimated the incidence of extrahepatic complications and employed Kaplan-Meier curves and Cox regression to assess the association of SVR/INF strata adjusted for a series of confounders. Data from 1676 patients were analyzed (20.29 % started an INF-based regimen). Overall, the incidence of CKD, DM, CVD, and death was 5.32 [95 % confidence interval (CI) 3.99-6.98], 10.13 (95 % CI 8.20-12.37), 6.79 (95 % CI 5.26-8.65), and 13.49 (95 % CI 11.29-16.0) per 1000 person-years of follow-up, respectively. In the Cox model for treated patients, SVR was not associated with a lower risk of CKD, DM, CVD, and death compared to non-SVR. Cirrhosis was significantly associated with a higher risk of CKD [hazard ratio (HR) 2.13; 95 % CI 1.06-4.31], DM (HR 3.48;, and death (HR 6.18;), but not of CVD (HR 1.14; 95 % CI 0.57-2.3). There are still many unknowns regarding the impact of SVR on the occurrence of extrahepatic complications in coinfected HIV/ HCV patients. Further investigations are needed in order to elucidate the role of SVR as an independent prognostic factor for extrahepatic events.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Leone

Prosperi

Costarelli

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…Achievement of SVR after treatment of hepatitis C is associated with a reduction in liver-related mortality in HIV-negative 36 and HIV-positive patients. 37 The impact of anti-HCV therapy on the survival or the risk of decompensations in HIV/HCV-coinfected patients with compensated cirrhosis has been only assessed in two previous cohort studies with apparent conflicting data. 33,38 In the present study, neither exposure to HCV therapy nor achieving SVR during follow-up were associated with a lower risk of developing decompensations.…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

Merchante

Rivero‐Juárez

Téllez³

et al. 2012

Hepatology

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on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS 40 kPa (P 5 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P 5 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P 5 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P 5 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P 5 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P 5 0.08) was of borderline significance. Conclusion: LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score. (HEPATOLOGY 2012;56:228-238)

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“…Another potential benefit may be reduced risk of HAART associated hepatotoxicity with sustained HCV clearance [111]. The failure to achieve a SVR in co-infected patients was associated with an increased risk of overall mortality, liver related mortality and hepatic decompensation [76,112].…”

Section: Haart Considerations In Hiv/hcv Co-infected Patientsmentioning

confidence: 99%

HIV Co-Infections with Hepatitis B and C

Singhatiraj

Suri²,

Goulston³

2013

J AIDS Clin Res

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Sustained virological response to interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with human immunodeficiency virus and hepatitis C virus

Cited by 279 publications

References 20 publications

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

HIV Co-Infections with Hepatitis B and C

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