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HIV infection does not increase the risk of liver complications in hepatitis C virus-infected patient with advanced fibrosis, after sustained virological response with direct-acting antivirals

AuthorsCorma-Gómez, Anaïs; Morano-Amado, Luis E.; Téllez, Francisco; Rivero-Juárez, Antonio; Real, Luis Miguel; Alados, Juan Carlos; Ríos-Villegas, María José; Vera-Méndez, Francisco Jesús; Palacios, Rosario; Geijo, Paloma; Macias, Juan; Pineda, Juan A.
Direct-acting antivirals
Hepatitis C virus
Hepatocellular carcinoma
Sustained virological response
Issue Date2019
PublisherLippincott Williams & Wilkins
CitationAIDS 33(7): 1167-1174 (2019)
Abstract[Objective]: To assess the impact of HIV coinfection on the risk of developing liver-related complications in HCV-infected patients with advanced fibrosis treated with direct-acting antivirals (DAA) after sustained virological response (SVR).
[Design]: Prospective cohort study.
[Setting]: Multicenter.
[Subjects]: Patients from the GEHEP and HEPAVIR cohorts were selected if they fulfilled the following criteria: treatment against HCV with all oral DAA combination; SVR achievement, defined as undetectable plasma HCV RNA 12 weeks after the end of therapy; pretreatment liver stiffness equal to or higher than 9.5 kPa; liver stiffness measurement at the time of SVR.
[Main outcome measure(s)]: The primary variable was the time until the development of a liver complication or requiring liver transplant.
[Results]: Seven hundred and seventeen patients were included and 507 (71%) were coinfected with HIV. After a median follow-up time of 21 (14–25) months, 15 (2.1%) patients developed a liver complication and/or underwent a liver transplant and 15 (2.0%) died. The probability of remaining free of hepatic complications or transplant at 1 and 2 was, respectively, 99 and 96% in HCV-monoinfected patients and 99 and 98% in coinfected patients (P = 0.648). In a multivariate analysis, in which nonliver-related death was considered as a competing event, HIV coinfection was not associated with the appearance of hepatic complications or requiring liver transplant [hazard ratio = 0.24; 95% CI (0.03–1.93), P = 0.181]. Having presented hepatic decompensation prior to SVR [hazard ratio = 29.06; 95% CI (3.91–216.16), P < 0.001] and the value of liver stiffness at the SVR time-point (hazard ratio = 1.12; 95% CI (1.07–1.18), P < 0.001] were associated with a higher probability of development of liver events.
[Conclusion]: HIV coinfection is not associated with a higher probability of developing liver complications in HCV-infected patients with advanced fibrosis, who achieved SVR with interferon-free regimens.
DescriptionOn behalf of RIS-HEP13 and GEHEP 011 study groups.
Publisher version (URL)https://doi.org/10.1097/QAD.0000000000002186
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