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HIV infection does not increase the risk of liver complications in hepatitis C virus-infected patient with advanced fibrosis, after sustained virological response with direct-acting antivirals

Corma-Gómez, Anaïsa; Morano, Luisb; Téllez, Franciscoc; Rivero-Juárez, Antoniod; Real, Luis M.a; Alados, Juan Carlose; Ríos-Villegas, María Joséf; Vera-Méndez, Francisco Jesúsg; Muñoz, Rosario Palaciosh; Geijo, Palomai; Macías, Juana; Pineda, Juan A.a on behalf of RIS-HEP13 and GEHEP 011 study groups

doi: 10.1097/QAD.0000000000002186
CLINICAL SCIENCE
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Objective: To assess the impact of HIV coinfection on the risk of developing liver-related complications in HCV-infected patients with advanced fibrosis treated with direct-acting antivirals (DAA) after sustained virological response (SVR).

Design: Prospective cohort study.

Setting: Multicenter.

Subjects: Patients from the GEHEP and HEPAVIR cohorts were selected if they fulfilled the following criteria: treatment against HCV with all oral DAA combination; SVR achievement, defined as undetectable plasma HCV RNA 12 weeks after the end of therapy; pretreatment liver stiffness equal to or higher than 9.5 kPa; liver stiffness measurement at the time of SVR.

Main outcome measure(s): The primary variable was the time until the development of a liver complication or requiring liver transplant.

Results : Seven hundred and seventeen patients were included and 507 (71%) were coinfected with HIV. After a median follow-up time of 21 (14–25) months, 15 (2.1%) patients developed a liver complication and/or underwent a liver transplant and 15 (2.0%) died. The probability of remaining free of hepatic complications or transplant at 1 and 2 was, respectively, 99 and 96% in HCV-monoinfected patients and 99 and 98% in coinfected patients (P = 0.648). In a multivariate analysis, in which nonliver-related death was considered as a competing event, HIV coinfection was not associated with the appearance of hepatic complications or requiring liver transplant [hazard ratio = 0.24; 95% CI (0.03–1.93), P = 0.181]. Having presented hepatic decompensation prior to SVR [hazard ratio = 29.06; 95% CI (3.91–216.16), P < 0.001] and the value of liver stiffness at the SVR time-point (hazard ratio = 1.12; 95% CI (1.07–1.18), P < 0.001] were associated with a higher probability of development of liver events.

Conclusion: HIV coinfection is not associated with a higher probability of developing liver complications in HCV-infected patients with advanced fibrosis, who achieved SVR with interferon-free regimens.

aUnit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville

bUnit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo

cUnit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz

dUnit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Universidad de Córdoba (UCO)

eUnit of Clinical Microbiology, University Hospital Jerez, Cadiz

fUnit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla

gSection of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena

hUnit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Málaga

iUnit of Infectious Diseases Hospital Virgen de la Luz, Cuenca, Spain.

Correspondence to Dr Juan A. Pineda, Professor, Unit of Infectious Diseases, Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014 Sevilla, Spain. Tel: +34 955015684; fax: +34 955015795; e-mail: japineda@telefonica.net

Received 30 October, 2018

Revised 30 November, 2018

Accepted 30 November, 2018

Copyright © 2019 Wolters Kluwer Health, Inc.