Fibrosis May Regress in HIV-HCV Coinfected Patients with Sustained Response to
Pegylated Interferon plus Ribavirin|
coinfected people who achieve a sustained response to hepatitis C treatment with
pegylated interferon plus ribavirin and some non-responders as well experience
regression of fibrosis and even cirrhosis, according to a study at the Fifth International
AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention this week
in Cape Town, South Africa.|
studies indicate that liver
fibrosis tends to progress more rapidly in HIV-HCV coinfected people than
in those with hepatitis C virus (HCV) infection
alone. Some research in HIV negative patients has demonstrated that interferon-based
therapy may stabilize or even reverse fibrosis, but this has not been extensively
studied in coinfected patients.
biopsy is still considered the "gold standard" for assessing liver
damage, but it is uncomfortable, expensive and carries a small risk of complications.
Researchers have explored a variety of non-invasive methods including transient
elastometry or FibroScan, which uses sound waves to measures liver stiffness.
researchers assessed fibrosis outcomes among HIV-HCV coinfected patients who underwent
hepatitis C treatment between 2000 and 2008. They also evaluate the accuracy of
FibroScan for estimating liver damage in this population.
participants (80%) were men, with a mean age of 41 years. Half had hard-to-treat
HCV genotype 1 and about one-third had genotype 3. At baseline, about half had
mild or moderate fibrosis and 23% had evidence of cirrhosis. Overall, the patients
had well-controlled HIV disease; 78% had HIV RNA < 50 copies/mL and the average
CD4 cell count was about 500 cells/mm3, though the lowest-ever count was 172 cells/mm3
and about one-quarter had received an AIDS diagnosis.
were treated with pegylated interferon
alfa (either Pegasys or PegIntron) plus
800-1200 mg/day weight-adjusted ribavirin. Treatment was planned for 48 weeks,
and about half completed the full course.
of 294 participants in the treatment study, a subset of 171 underwent a liver
biopsy before treatment,157 also were tested using FibroScan during follow-up
(median 44 months after treatment), and 96 received a second FibroScan (a median
52 months after treatment, or about 8 months after the first test). Fibrosis scores
ranged from 1 (absent or mild fibrosis) to 4 (cirrhosis). Fibrosis regression
was defined as a decrease of at least 1 point.
43% of the patients achieved sustained virological response (SVR), or continued
undetectable HCV viral load 6 months after the end of treatment.|
outcomes were fairly evenly distributed:|
28% experienced regression;|
35% had no change;
37% experienced progression.
who achieved SVR were significantly more likely than non-responders to experience
least a 1 point decrease: 38% of sustained responders vs 22% of non-responders;|
least a 2 point decrease: 24% of sustained responders vs 6% of non-responders.
participants with more advanced liver disease experienced cirrhosis reversal.|
least a 1 point decrease: 44% of sustained responders vs 23% of non-responders;|
least a 2 point decrease: 33% of sustained responders vs 18% of non-responders.|
patients who received a second FibroScan test, results were similar or better,
indicating continued improvement over time.|
mean decrease in fibrosis score was -0.36 according to the first FibroScan, with
an additional decline of -0.21 according to the second test.|
adjusting for potential confounding variables, SVR was the only factor significantly
associated with fibrosis regression (relative risk 0.76). |
contrast with prior studies, HCV genotype, baseline HCV viral load, CD4 cell count,
and type of hepatitis C treatment, and use of antiretroviral therapy were not
significant predictors of response.|
study demonstrates fibrosis improvement after HCV therapy in an important proportion
of HCV-HIV [coinfected] patients," especially those who achieve sustained
virological response, the investigators concluded.
less common, fibrosis regression and a lower fibrosis progression rate were also
observed in some virological non-responders, which the researchers attributed
to the anti-fibrogenic and pro-fibrolytic properties of the treatment.
findings support wider use of hepatitis C treatment in HIV-HCV coinfected patients,
they suggested, stating that the "goals of future therapies for viral hepatitis
should be aimed towards fibrosis regression as well as viral eradication."
Marti-Belda, C Quereda, JL Casado, and others. Fibrosis regression in HIV/HCV
coinfected patients with sustained virological response to pegylated interferon
plus ribavirin. 5th International AIDS Society Conference on HIV Pathogenesis,
Treatment, and Prevention (IAS 2009). July 19-22, 2009. Cape Town, South Africa.