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Abstract Details
Low risk of liver decompensation among human immunodeficiency virus/hepatitis c virus-coinfected patients with mild fibrosis in the short-term
Macías J1, Mancebo M, Márquez M, Merino D, Téllez F, Rivero A, von Wichmann MA, López-Cortés LF, Merchante N, Santos J, Raffo M, Pérez-Pérez M, Camacho Á, Iribarren JA, Pineda JA. Hepatology. 2014 Dec 24. doi: 10.1002/hep.27674. [Epub ahead of print]
Author information
1Infectious Diseases and MicrobiologyUnit, Hospital Universitario de Valme, Seville, Spain.
Abstract
Liver fibrosis is used to make decisions about the timing of therapy against HCV in routine clinical practice should be based on the short-term likelihood of liver decompensations (DC). Thus, we aimed at evaluating the risk of DC and death among HIV/HCV-coinfected individuals according to their baseline fibrosis classified by either liver biopsy or liver stiffness measurement (LSM). HIV/HCV-coinfected patients, naïve or without SVR to HCV therapy, were included in this cohort. Fibrosis was classified by biopsy in 683 patients and by LSM in 1046 individuals. Reference categories were fibrosis stage 0 and LSM <6KPa. For patients with biopsy, the adjusted subhazard ratio for DC [ASHR, 95% confidence interval (95% CI) by fibrosis stage was: Stage 1; 2.3 (0.27-20.3), p=0.443; Stage 2, 2.8 (0.33-24), p=0.345; Stage 3, 4.91 (0.60-41), p=0.137; Stage 4, 9.89 (1.25-79.5), p=0.030. For patients with LSM, the ASHR (95% CI) by LSM category was: 6-9.4 KPa; 1.89 (0.18-20.3), p=0.599; 9.5-14.5 KPa; 6.59 (0.73-59.2), p=0.092; ≥14.6 KPa; 59.5 (8.3-427), p<0.0001. Regarding the risk of death, the adjusted hazard ratio [AHR (96% CI) for death by fibrosis stage was: Stage 1, 1.3 (0.4-4.11), p=0.677; Stage 2, 2.68 (0.86-8.36), p= 0.090; Stage 3, 2.58 (0.82-8.15), p=0.106; Stage 4, 4.35 (1.43-13.3), p=0.010. For patients with LSM, the AHR (95% CI) for death by LSM was: 6-9.4 KPa, 1.7 (0.63-4.79), p=0.288; 9.5-14.5 KPa, 3.38 (1.2-9.5), p=0.021; ≥14.6 KPa, 12.7 (4.9-33.6), p<0.0001. In conclusion, HIV/HCV-coinfected patients without advanced fibrosis are at very low risk of DC in the short-term. In them, deferral of HCV therapy for a few years and monitoring fibrosis progression is a safe option until cheaper, more effective and convenient HCV treatment becomes widely available.