Treatment with Interferon-based Therapy Reduces the Risk of End-stage Liver Disease in HIV-HCV Coinfected Patients

Research has produced conflicting data about liver disease progression in HIV-HCV coinfected patients, but a majority of studies suggest that HIV positive individuals may experience faster progression to advanced fibrosis or cirrhosis than people with HCV alone.

Combination therapy with pegylated interferon plus ribavirin slows (and may even reverse) liver disease progression in HCV monoinfected patients -- even those who do not achieve sustained virological response (SVR) -- but this has not been extensively studied in coinfected individuals.

At the recent 58th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2007) in Boston (November 2-6, 2007), French researchers reported on a study evaluating the long-term benefits of anti-HCV therapy in coinfected patients followed for 5 years.

The investigators prospectively followed 383 HIV positive patients with chronic hepatitis C enrolled in a randomized, controlled trial of interferon plus ribavirin who received at least 1 dose of study medication.

About three-quarters were men, the average age was 40 years, 83% were on HAART, and most had well-controlled HIV disease with a mean CD4 cell count of 532 cells/mm3 and 66% with an HIV viral load < 400 copies/mL. About half had HCV genotype 1 or 4 and 20% were prior non-responders with genotype 2 or 3. At baseline, the mean Metavir fibrosis score was F2.2, and 36% had advanced fibrosis or cirrhosis (stage F3-F4).

The median follow-up period was 60 months. The study assessed the risk of end-stage liver disease (ESLD), defined as a liver decompensation, liver transplantation, hepatocellular carcinoma, or death.

Results

• 71 patients (29%) achieved SVR to combination hepatitis C treatment.

• 21 patients (5.4%) experienced ESLD events during the follow-up period, 13 of whom died.

• No patients died of AIDS-related causes.

• Factors independently associated with an increased risk of ESLD were:

- Metavir fibrosis score of F3 or F4 (HR 3.2; P=0.046);

- CD4 cell count < 350 cells/mm3 (hazard ratio [HR] 2.7; P=0.03);

- Platelet count < 190 000 cells/mm3 (HR 4.6; P=0.04);

- Prothrombin time < 94% (HR 6.4; P=0.01).

• SVR was associated with a decreased risk of ESLD, although the difference did not reach statistical significance (HR 0.18; P=0.09).

Conclusion

"Our results suggest that HCV SVR achieved by interferon-ribavirin combination [therapy] may decrease the incidence of [ESLD] in HIV-HCV coinfected patients," the researchers concluded. They added, however, that a longer follow-up period is needed to reach a firm conclusion.

11/09/07

Reference
F Bani-Sadr, I Goderel, C Berendjem, and others. Five years assessment of the risk of end-stage liver disease in HIV/HCV co-infected patients treated for a chronic HCV infection. 58th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2007). Boston. November 2-6, 2007. Abstract 259.