Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals

被引:28
作者
Corma-Gomez, A. [1 ]
Macias, J. [1 ]
Tellez, F. [2 ]
Freyre-Carrillo, C. [3 ]
Morano, L. [4 ]
Rivero-Juarez, A. [5 ]
Rios, M. J. [6 ]
Alados, J. C. [7 ]
Vera-Mendez, F. J. [8 ]
Merchante, N. [1 ]
Palacios, R. [9 ]
Granados, R. [10 ]
Merino, D. [11 ]
De Los Santos, I [12 ]
Pineda, J. A. [1 ]
机构
[1] Hosp Univ Valme, Unit Infect Dis & Microbiol, Seville, Spain
[2] Univ Cadiz, Hosp Univ Puerto Real, Fac Med, Unit Infect Dis, Cadiz, Spain
[3] Univ Cadiz, Hosp Univ Puerto Real, Fac Med, Unit Microbiol, Cadiz, Spain
[4] Hosp Univ Alvaro Cunqueiro, Unit Infect Pathol, Vigo, Spain
[5] Univ Cordoba UCO, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Unit Infect Dis, Cordoba, Spain
[6] Hosp Univ Virgen Macarena, Unit Infect Dis, Seville, Spain
[7] Univ Hosp Jerez, Unit Clin Microbiol, Cadiz, Spain
[8] Hosp Gen Univ Santa Lucia, Serv Internal Med, Sect Infect Med, Cartagena, Spain
[9] Hosp Virgen Victoria, Unit Infect Dis & Microbiol, Malaga, Spain
[10] Hosp Univ Gran Canaria Dr Negrin, Unit Infect Dis, Las Palmas Gran Canaria, Spain
[11] Hosp Juan Ramon Jimenez & Infanta Elena, Unit Infect Dis, Huelva, Spain
[12] Hosp La Princesa, Unit Internal Med & Infect Dis, Madrid, Spain
关键词
HIV/HCV coinfection; sustained virological response; direct-acting antivirals; cirrhosis; hepatocellular carcinoma; VENOUS-PRESSURE GRADIENT; HEPATOCELLULAR-CARCINOMA; NONINVASIVE ASSESSMENT; COINFECTED PATIENTS; RISK; CIRRHOSIS; DECOMPENSATION; COMPLICATIONS; INFECTION; DISEASE;
D O I
10.1093/cid/ciz1140
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA). Methods. In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS >= 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication-hepatic decompensation or hepatocellular carcinoma (HCC)-or requiring liver transplant after SVR. Results. During a median (Q1-Q3) follow-up of 31.6 (22.7-36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28-9.12]), pretreatment CPT class B or C (62.5 [3.08-1246.42]) and MELD scores (1.37 [1.03-1.82]), CPT class B or C at SVR (10.71 [1.32-87.01]), CD4 cell counts <200/mu L at SVR time-point (4.42 [1.49-13.15]), FIB-4 index at SVR (1.39 [1.13-1.70]), and LS at SVR (1.05 [1.02-1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant. Conclusions. LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.
引用
收藏
页码:2354 / 2362
页数:9
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