Clinical

In HIV/HCV coinfection, treating cirrhosis improves outcomes

Last Updated: 2013-03-07 15:10:13 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - In HIV/HCV-coinfected patients with compensated cirrhosis, sustained virologic responses to standard treatment of chronic hepatitis C are associated with improved outcomes, researchers from Spain report.

"Eradication of HCV due to therapy with pegylated interferon plus ribavirin reduces the risk of liver decompensation and mortality in HIV/HCV-coinfected patients with compensated cirrhosis, a finding which has been not reported," Dr. Jose A. Mira Escarti from Hospital Universitario de Valme, Sevilla, Spain told Reuters Health by email.

Previous studies have shown these benefits in HIV/HCV-coinfected patients without cirrhosis. Those results led Dr. Mira and colleagues to review their data on 166 coinfected cirrhotics treated with pegylated interferon plus ribavirin.

Forty-three patients (25%) achieved a sustained virologic response (SVR), according to the report online February 19th in Clinical Infectious Diseases.

Thirty-five patients developed hepatic decompensation during a median follow-up of close to four and a half years. Only two SVR patients (4.6%) developed liver decompensation, compared with 33 patients (26.8%) who did not achieve SVR (p=0.002).

The probability of developing hepatic decompensation was 0% at one year and 4% at three years for SVR patients, compared with 15% and 32%, respectively, for non-SVR patients.

There was no difference in incidence of hepatocellular carcinoma between the SVR and non-SVR groups (2.3% vs 3.3%).

Twenty-four patients (14.5%) died during follow-up, including two SVR patients and 22 non-SVR patients (4.6% vs 17.9%; p=0.02).

The probability of overall mortality in the SVR group was 0% at one year and 4% at three years, whereas the probability in the non-SVR group was 12% at one year and 20% at three years.

Two SVR patients and 15 non-SVR patients died of liver failure (4.6% vs 12.2%), but this difference fell short of statistical significance.

"Consequently, HCV therapy is a priority among HIV-infected patients with chronic hepatitis C, especially in those with compensated liver cirrhosis," Dr. Mira concluded.

"There are other interventions in order to reduce the rate of hepatic events and mortality, mainly to receive potent antiretroviral therapy and to avoid alcohol use," Dr. Mira added.

Also, he said, the management of compensated cirrhosis includes abdominal ultrasound exams every six months to screen for hepatocellular carcinoma, plus endoscopy to diagnose and treat upper gastrointestinal hemorrhage.

"But the best tool," Dr. Mira said, "is HCV therapy in order to avoid the progression to cirrhosis."

SOURCE: http://bit.ly/15Ao2TZ

Clin Infect Dis 2013.