title: Low risk of liver decompensation among human immunodeficiency virus/hepatitis C virus-coinfected patients with mild fibrosis in the short term.
abstract: Liver fibrosis is used to make decisions about the timing of therapy against hepatitis C virus (HCV) in routine clinical practice, which should be based on the short-term likelihood of liver decompensations. Thus, we aimed at evaluating the risk of decompensations and death among human immunodeficiency virus (HIV)/HCV-coinfected individuals according to their baseline fibrosis classified by either liver biopsy or liver stiffness measurement (LSM). Patients coinfected with HIV/HCV, naive or without sustained virological response to HCV therapy, were included in this cohort. Fibrosis was classified by biopsy in 683 patients and by LSM in 1046 individuals. Reference categories were fibrosis stage 0 and LSM <6 kPa. For patients with biopsy, the adjusted subhazard ratio for decompensations and 95% confidence interval (95% CI) by fibrosis stage were as follows: stage 1, 2.3 (0.27-20.3), P = 0.443; stage 2, 2.8 (0.33-24), P = 0.345; stage 3, 4.91 (0.60-41), P = 0.137; stage 4, 9.89 (1.25-79.5), P = 0.030. For patients with LSM, the adjusted subhazard ratio and 95% CI by LSM category were as follows: 6-9.4 kPa, 1.89 (0.18-20.3), P = 0.599; 9.5-14.5 kPa, 6.59 (0.73-59.2), P = 0.092; ≥14.6 kPa, 59.5 (8.3-427), P < 0.0001. Regarding the risk of death, the adjusted hazard ratio and 95% CI for death by fibrosis stage were as follows: stage 1, 1.3 (0.4-4.11), P = 0.677; stage 2, 2.68 (0.86-8.36), P = 0.090; stage 3, 2.58 (0.82-8.15), P = 0.106; stage 4, 4.35 (1.43-13.3), P = 0.010. For patients with LSM, the adjusted hazard ratio and 95% CI for death by LSM were as follows: 6-9.4 kPa, 1.7 (0.63-4.79), P = 0.288; 9.5-14.5 kPa, 3.38 (1.2-9.5), P = 0.021; ≥14.6 kPa, 12.7 (4.9-33.6), P < 0.0001.
  
  
  CONCLUSIONS
  Patients coinfected with HIV/HCV without advanced fibrosis are at very low risk of decompensations in the short term; deferral of HCV therapy for a few years and monitoring fibrosis progression is a safe option until cheaper, more effective, and more convenient HCV treatment becomes widely available.
authors.affiliation: Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: María
authors.initials: M
authors.lastname: Mancebo
authors.forename: Manuel
authors.initials: M
authors.lastname: Márquez
authors.forename: Dolores
authors.initials: D
authors.lastname: Merino
authors.forename: Francisco
authors.initials: F
authors.lastname: Téllez
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.forename: Miguel A
authors.initials: MA
authors.lastname: von Wichmann
authors.forename: Luis F
authors.initials: LF
authors.lastname: López-Cortés
authors.forename: Nicolás
authors.initials: N
authors.lastname: Merchante
authors.forename: Jesús
authors.initials: J
authors.lastname: Santos
authors.forename: Miguel
authors.initials: M
authors.lastname: Raffo
authors.forename: Montserrat
authors.initials: M
authors.lastname: Pérez-Pérez
authors.forename: Ángela
authors.initials: Á
authors.lastname: Camacho
authors.forename: Jose A
authors.initials: JA
authors.lastname: Iribarren
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000328:Adult; D060085:Coinfection / Q000150:complications*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D017093:Liver Failure / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors