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- Title
Risk of Liver Decompensation Among HIV/Hepatitis C Virus–Coinfected Individuals With Advanced Fibrosis: Implications for the Timing of Therapy.
- Authors
Macías, Juan; Márquez, Manuel; Téllez, Francisco; Merino, Dolores; Jiménez-Aguilar, Patricia; López-Cortés, Luis F.; Ortega, Enrique; von Wichmann, Miguel A.; Rivero, Antonio; Mancebo, María; Santos, Jesús; Pérez-Pérez, Montserrat; Suárez-Lozano, Ignacio; Romero-Palacios, Alberto; Torres-Cornejo, Almudena; Pineda, Juan A.
- Abstract
Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)–coinfected patients with advanced fibrosis, without cirrhosis, are at risk of liver decompensations from the first year after the staging of fibrosis. Therapy against HCV without delay is warranted for patients with precirrhosis and HIV coinfection.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 × 103 vs ≥100 × 103: 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.
- Subjects
CHRONIC hepatitis C; FIBROSIS; LIVER diseases; HIV; CIRRHOSIS of the liver; MEDICAL research
- Publication
Clinical Infectious Diseases, 2013, Vol 57, Issue 10, p1401
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cit537