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Advanced liver disease outcomes after hepatitis C eradication by human immunodeficiency virus infection in PITER

Maria Giovanna Quaranta1, Luigina Ferrigno1, Monica Monti2

  • 1Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.

Hepatology International
|April 13, 2020
PubMed

Insights

Hepatitis C Virus (HCV) eradication with direct-acting antivirals (DAAs) does not eliminate liver disease progression in patients with cirrhosis, regardless of Human Immunodeficiency Virus (HIV) coinfection. HIV coinfection did not increase liver complication risks post-eradication in this cohort.

Area of Science:

  • Hepatology
  • Virology
  • Infectious Diseases

Background:

  • Direct-acting antiviral (DAA) therapy has revolutionized Hepatitis C Virus (HCV) eradication.
  • Understanding long-term liver disease progression post-HCV eradication, particularly in Human Immunodeficiency Virus (HIV) coinfected patients, is crucial for real-world management.
  • The impact of pre-existing liver cirrhosis on outcomes after successful HCV treatment in coinfected individuals requires further investigation.

Purpose of the Study:

  • To evaluate liver disease progression after HCV eradication with DAAs in a real-life setting.
  • To specifically assess the influence of HIV coinfection on liver disease outcomes following DAA treatment in patients with pre-treatment liver cirrhosis.

Main Methods:

  • A cohort study analyzed patients treated with DAAs between April 2014 and June 2019 with at least 12 weeks of follow-up.
  • Cox regression analysis was employed to identify factors associated with liver disease outcomes, including HIV coinfection, in patients with pre-treatment liver cirrhosis.
  • Outcomes assessed included hepatocellular carcinoma (HCC) incidence and hepatic decompensation.

Main Results:

  • No significant difference in cumulative HCC incidence or hepatic decompensation was observed between 93 HIV/HCV coinfected and 1109 HCV monoinfected patients.
  • Factors independently associated with HCC incidence included older age, male sex, lower albumin levels, HCV genotype 3, and positivity for serum anti-HBc.
  • Older age, male sex, and lower albumin levels were independently associated with hepatic decompensation events post-viral eradication.

Conclusions:

  • While DAA treatment leads to HCV eradication, liver disease progression, including HCC and decompensation, persists in patients with established cirrhosis, irrespective of HIV coinfection.
  • In patients with cirrhosis, HIV coinfection was not found to be an independent risk factor for increased liver complications after successful HCV viral eradication.
  • Demographic, clinical, and genotypic differences exist between HIV-coinfected and HCV-monoinfected populations, highlighting the need for tailored management strategies.
Abstract

Keywords:
Advanced liver diseaseCirrhosisClinical outcomesCoinfectionDirect-acting antiviralsHepatitis C virusHepatocellular carcinomaHuman immunodeficiency virusReal-life cohortSustained virological responseViral eradication

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