title: Clinical effects of viral relapse after interferon plus ribavirin in patients co-infected with human immunodeficiency virus and hepatitis C virus.
abstract: OBJECTIVE
  Sustained viral response (SVR) after therapy with interferon-ribavirin (IF-RB) reduces liver-related (LR) complications and mortality in HIV/HCV-co-infected patients. Here, we assess the impact of end-of-treatment response with subsequent relapse (REL) on LR events (LR death, liver decompensation, hepatocellular carcinoma, or liver transplantation), and liver stiffness (LS) by transient elastography.
  
  
  METHODS
  We analyzed the GESIDA 3603 Cohort (HIV/HCV-co-infected patients treated with IF-RB in 19 centers in Spain). Response to IF-RB was categorized as SVR, REL, and no response (NR). The study started when IF-RB was stopped and ended at death or the last follow-up visit. Multivariate regression analyses were adjusted for age, sex, HIV category of transmission, CDC clinical category, nadir CD4+ cell count, HCV genotype, HCV-RNA viral load, and liver fibrosis.
  
  
  RESULTS
  Of 1599 patients included, response was categorized as NR in 765, REL in 250 and SVR in 584. Median follow-up was more than 4 years in each group. Taking the group of patients with NR as reference, we found that the adjusted hazard ratios (95% confidence interval) of liver-related events (liver-related death, liver decompensation, hepatocellular carcinoma, liver transplantation) for patients with REL and for patients with SVR were 0.17 (0.05; 0.50) and 0.03 (0; 0.20), respectively. We also found that SVR was followed by less liver stiffness than both REL and NR. However, REL was associated with less liver stiffness than NR.
  
  
  CONCLUSIONS
  Best outcomes were achieved with an SVR. However, REL was associated with less LR mortality, decompensation, and liver stiffness than NR.
authors: Hospital General Universitario Gregorio Marañón, Madrid, Spain. jbb4@me.com
authors: Juan
authors: J
authors: Berenguer
authors: Julio
authors: J
authors: Alvarez-Pellicer
authors: Ana
authors: A
authors: Carrero
authors: Miguel A
authors: MA
authors: Von Wichmann
authors: José
authors: J
authors: López-Aldeguer
authors: Josep
authors: J
authors: Mallolas
authors: María J
authors: MJ
authors: Galindo
authors: Eva
authors: E
authors: Van Den Eynde
authors: María J
authors: MJ
authors: Téllez
authors: Carmen
authors: C
authors: Quereda
authors: Cristina
authors: C
authors: Tural
authors: José
authors: J
authors: Sanz
authors: Carlos
authors: C
authors: Barros
authors: Ignacio
authors: I
authors: Santos
authors: Federico
authors: F
authors: Pulido
authors: Josep M
authors: JM
authors: Guardiola
authors: Enrique
authors: E
authors: Ortega
authors: Rafael
authors: R
authors: Rubio
authors: Juan J
authors: JJ
authors: Jusdado
authors: María L
authors: ML
authors: Montes
authors: Gabriel
authors: G
authors: Gaspar
authors: Elena
authors: E
authors: Barquilla
authors: José M
authors: JM
authors: Bellón
authors: Juan
authors: J
authors: González-García
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy*; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000821:virology*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D007372:Interferons / Q000008:administration & dosage*; D008099:Liver / Q000473:pathology; D008297:Male; D016016:Proportional Hazards Models; D012254:Ribavirin / Q000008:administration & dosage*
chemical_list: D012254:Ribavirin; D007372:Interferons; D000410:Alanine Transaminase