Risk of liver decompensation among HIV/hepatitis C virus-coinfected individuals with advanced fibrosis: implications for the timing of therapy.
BACKGROUND
Most human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-infected patients who are currently receiving boceprevir or telaprevir-based therapy against HCV show cirrhosis. However, the risk of liver decompensation (DC) among HIV/HCV-coinfected patients with stage 3 fibrosis in the short term could be high enough to not allow delays. We aimed at assessing the risk of DC among HIV/HCV-coinfected individuals with advanced fibrosis (F3-F4).


METHODS
Eight hundred ninety-two HIV/HCV-coinfected patients, naive or without sustained virologic response to HCV therapy, were included in this cohort. Fibrosis was staged by biopsy in 317 patients and by liver stiffness measurement (LSM) in 575 individuals. Precirrhosis was defined as an LSM of 9.5-14.6 kilopascals (kPa), and cirrhosis as an LSM of ≥14.6 kPa.


RESULTS
For patients with biopsy, the probability of remaining free of DC for F3 vs F4 was 99% (95% confidence interval [CI], 95%-100%) vs 96% (95% CI, 91%-98%) at 1 year, and 98% (95% CI, 94%-100%) vs 87% (95% CI, 81%-92%) at 3 years. The only factor independently associated with DC was fibrosis stage (F4 vs F3, subhazard ratio [SHR], 2.1; 95% CI, 1.07-4.1; P = .032). For patients with LSM, the probability of remaining free of DC for precirrhosis vs cirrhosis was 99% (95% CI, 96%-100%) vs 93% (95% CI, 89%-96%) at 1 year, and 97% (95% CI, 94%-99%) vs 83% (95% CI, 77%-87%) at 3 years. Factors independently associated with DC were platelet count (<100 × 10(3) vs ≥100 × 10(3): SHR, 1.86; 95% CI, 1.01-3.42; P = .046) and LSM (cirrhosis vs precirrhosis: SHR, 5.67; 95% CI, 2.27-14.1; P < .0001).


CONCLUSIONS
As in patients with cirrhosis, immediate therapy against HCV is warranted for patients with precirrhosis and HIV coinfection, as they are at risk of DC soon after the diagnosis of advanced fibrosis.
Infectious Diseases and Microbiology Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Seville.
Juan
J
Macías
Manuel
M
Márquez
Francisco
F
Téllez
Dolores
D
Merino
Patricia
P
Jiménez-Aguilar
Luis F
LF
López-Cortés
Enrique
E
Ortega
Miguel A
MA
von Wichmann
Antonio
A
Rivero
María
M
Mancebo
Jesús
J
Santos
Montserrat
M
Pérez-Pérez
Ignacio
I
Suárez-Lozano
Alberto
A
Romero-Palacios
Almudena
A
Torres-Cornejo
Juan A
JA
Pineda
D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D005260:Female; D015658:HIV Infections / Q000821:virology*; D006526:Hepatitis C / Q000473:pathology* / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology*; D017093:Liver Failure / Q000473:pathology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chronic hepatitis C; liver biopsy; liver decompensations; liver fibrosis; liver stiffness