[ANRS HC 02 RIBAVIC: histo-pathological impact].
Anti-hepatitis C virus (HCV) therapy allows complete recovery of HCV infection (sustained virologic response). Reduction of necro-inflammation results usually in a stabilization then in a reduction of fibrosis and even of cirrhosis at least in patients with sustained virologic response. The randomised controlled RIBAVIC ANRS HC02 trial comparing the combination ribavirin-pegylated interferon-alpha2b versus ribavirine-standard interferon-alpha2b as first treatment in HIV-HCV co-infected patients allowed an analysis of 205 paired (pre- and post-treatment) biopsies using the Metavir and Ishak scores. A significant reduction was associated with sustained virologic response and non response with stabilization. There was no positive impact on fibrosis despite sustained virologic response and a deterioration in non responders. In multivariate analysis, didanosine and non response were significantly associated with fibrosis deterioration. The absence of fibrosis reversal in co-infected patients is related to virologic non response and probably to co-factors of fibrosis worsening, like the mitochondrial toxicity of antiretrovirals and especially of didanosine. In the RIBAVIC cohort (prospective followup of 383 co-infected HIV-HCV treated patients) with a median of 60 months, 21 patients (5 %) had a liver event: all were non responders and 20 had fibrosis score > or = F3. In multivariate analysis, factors associated with survival were virologic response to antiviral therapy, fibrosis score < F3 and baseline CD 4 count > 350/mL. These results emphasize the need of early therapeutic interventions to increase the rate of sustained virologic response and to decrease the rate of liver complications in the most severe patients.
Pol
S
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Université Paris Descartes, Unité d'Hépatologie, Hôpital Cochin, APHP, INSERM U.567, France. stanislas.pol@cch.aphp.fr
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000473:pathology*; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D004359:Drug Therapy, Combination; D005602:France; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology; D015999:Multivariate Analysis; D011092:Polyethylene Glycols / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b