By Liz Highleyman

Recent research has produced conflicting data about whether liver disease progression is worse in HIV-HCV coinfected patients, but a majority of studies suggest that HIV positive individuals may develop advanced fibrosis or cirrhosis than people with HCV alone.

Two studies at the recent 11th European AIDS Conference (EACS) in Madrid, Spain (October 24-27, 2007) looked at liver disease progression and the effect of anti-HCV treatment in HIV-HCV coinfected patients.

Prognosis of Patients with Advanced Liver Disease

In the first study, Spanish researchers assessed the prognosis of coinfected individuals with end-stage liver disease (ESLD) or liver decompensation, which can lead to esophageal bleeding, ascites (abdominal fluid accumulation), hepatic encephalopathy, and other serious conditions. In people with compensated disease, the liver may be heavily damaged, but is still able to carry out its essential functions.

The study included 373 HIV-HCV coinfected patients from 8 centers in Spain with diagnosed cirrhosis or advanced liver damage, 275 with compensated and 98 with decompensated disease. Both groups were similar with regard to sex (about 80% men), average age (44 years), and average length of time since HCV infection (23 years) and HIV infection (15 years).

Most (80%-90%) in both groups were on HAART, but patients with decompensated disease were significantly less likely to have received anti-HCV therapy (28% versus 65%). People with decompensated disease also had lower current and nadir CD4 cell counts and were less likely to have an undetectable HIV viral load.

Results

• During a median follow-up period of 18 months, patients with liver decompensation had a much higher mortality rate than those with compensated disease, with almost half dying during follow-up (48% vs 7%; P < 0.0001).

• After 1 year, 34% of those with decompensated liver disease either developed hepatocellular carcinoma (HCC), obtained a liver transplant, or died, versus 5% of those with compensated disease.

• After 2 years, the corresponding rates were 68% for patients with decompensated disease and 8% for those with compensated disease.

• After 3 years, the corresponding rates were 100% and 8%, respectively.

• The median time to HCC, liver transplantation, or death was 19 months among people with decompensated disease and 5.5 years among those with compensated disease.

• The 18-month risk of death rose with increasing liver disease severity scores, from 4% among those with Child-Pugh A to 73% among those with Child-Pugh C (P < 0.0001).

• However, the risk of developing liver decompensation among patients who started with compensated disease was low (4% after 1 year, 9% after 3 years).

Benefits of Anti-HCV Therapy

In the second study, French researchers retrospectively evaluated outcomes among 437 HIV-HCV coinfected patients (75% men) seen at Pitié Salpetrière Hospital in Paris between 1980 and 2006. About half received interferon-based hepatitis C treatment, mostly with pegylated interferon plus ribavirin.

Results

• After a mean follow-up period of 10 years, 38% of treated patients achieved SVR 6 months after completion of therapy.

• 7.2% of participants overall experienced liver decompensation (14.3% of treated patients and 4.4% of untreated individuals, because those with more advanced liver disease were more likely to receive anti-HCV therapy).

• Treated patients who achieved SVR had a lower risk of liver decompensation, at 2.3%.

• 4.6% patients overall died, including 8.6% of those who received anti-HCV treatment.

• However, just 1.2% of patients who achieved SVR died during follow-up.

• Treated patients benefited compared with untreated individuals, even if they did not achieve SVR.

Taken together, these findings suggest that HIV positive people should receive hepatitis C treatment early, before advanced liver damage occurs. Since this may happen sooner in coinfected patients, prompt treatment appears particularly urgent for this population.

11/09/07

References

M Lopez-Dieguez, JF Pascual, M Montes, and others. Morbidity and mortality in HIV infected patients with compensated and decompensated cirrhosis: prospective cohort of 373 patients. 11th European AIDS Conference (EACS). Madrid, Spain. October 24-27, 2007. Madrid, Spain. October 24-27, 2007. Abstract P8/2.

S Dominguez and others. Long-term impact of interferon (IFN)-based therapy on liver-related decompensation, hepatocellular carcinoma (HCC) and liver death in HIV/HCV co-infected patients: a retrospective cohort study. 11th EACS. Abstract PS8/3.