Patients coinfected with HIV and hepatitis C virus (HCV) are more likely to develop end-stage liver disease (ESLD) compared to patients who are HCV-monoinfected, according to a study presented by French researchers at the XVI International AIDS Conference held August 13-18, 2006, in Toronto. However, the researchers found that HIV/HCV-coinfected patients who achieved a sustained virological response to hepatitis C therapy were no more likely to progress to ESLD than their HCV-monoinfected peers.
Most studies show that coinfected patients experience more rapid liver fibrosis progression than those who are HCV-monoinfected, although this may be less likely if HIV is well-controlled. Coinfected patients are also less likely to respond to interferon (IFN)-based therapy.
Firouzé Bani-Sadr (INSERM, Paris) presented data from a study of liver disease progression among HIV/HCV-coinfected patients in France. The researchers prospectively followed 248 HIV/HCV-coinfected patients who received pegylated interferon (PEG-IFN) or conventional IFN, both with ribavirin (RBV), for 48 weeks in the RIBAVIC trial. Overall, 29% achieved sustained virological response, or continued undetectable hepatitis C viral load, 24 weeks after the completion of therapy.
The average age of the patients was 42 years, 75% were men, and 59% had hard-to-treat hepatitis C genotypes 1 or 4. Most (81%) were taking antiretroviral therapy for HIV, about half had HIV viral loads below 200 copies/mL, and the average CD4 count was 567 cells/mm3. At the start of the study, 35% already had severe liver fibrosis or cirrhosis.
After an average follow-up period of 33 months, 17 events indicative of ESLD occurred in nine patients (4%). These events included liver decompensation (with symptoms such as severely elevated bilirubin, ascites, hepatic encephalopathy, or bleeding esophageal varices), hepatocellular carcinoma, need for liver transplant, and liver-related death. Six patients died of liver-related causes and two of other causes.
All cases of ESLD occurred in patients who did not achieve sustained virological response to anti-hepatitis C therapy, and all but one occurred in patients who had advanced fibrosis at the start of the study. End-stage liver disease did not occur in patients with severe fibrosis who permanently cleared HCV with treatment. Among non-responders, ESLD was more common among patients with advanced fibrosis who also had lower CD4 counts.
In a stratified analysis, the only independent risk factors for ESLD were cirrhosis or severe fibrosis at the start of the study (P3 (P=0.022), and lack of sustained virological response to antihepatitis C therapy (P=0.068).
In conclusion, the researchers stated, "Our study confirms that the rate of spontaneous hepatic decompensation in coinfected patients with asymptomatic cirrhosis is higher (7.4% per year) than in [HCV]-monoinfected patients (3% to 4% per year)." The researchers further recommended that "clinicians should consider the evidence that sustained virological response seems associated with a reduction in long-term morbidity and mortality related to hepatitis C" when discussing treatment options with patients.
Editor's Note: Reprinted with permission from www.aidsmap.com (first e-published August 22, 2006).
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