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Fibrosis regression in HIV/HCV coinfected patients with sustained virological response to pegylated interferon plus ribavirin
Presented by Jose Luis Casado (Spain).
P. Marti-Belda, C. Quereda, J.L. Casado, A. Moreno, M.J. Perez-Elias, B. Hernandez-Novoa, F. Dronda, S. Moreno
Ramón y Cajal Hospital, Infectious Diseases, Madrid, Spain
Background: The possibility of fibrosis regression after HCV therapy has been postulated in several studies using paired biopsies. However, the need of repeated biopsies limits the confirmation of these results. The use of transient elastometry (FibroScan) could allow assessing the rate and timing of fibrosis regression.
Methods: Prospective cohort of 294 HCV/HIV coinfected patients treated with pegylated-interferon plus ribavirin with >1 year follow-up. In 171 cases a liver biopsy was performed before therapy, and FibroScan was performed in 96 of them during follow-up. Liver fibrosis was staged according to Ishak (1-no/mild fibrosis to 6-cirrhosis).
Results: Mean age was 41 years, 80% male, and 87% of patients were IDU. Main genotype distribution: 1 (50%) and 3 (36%). Most patients with fibrosis stage 1 or 2 (40%), whereas 23% had histological data of cirrhosis. Median time of known HCV infection was 17.6 years. Patients were treated for a median of 11 months (1-16), with 91% remaining 1 year on therapy, and 43% reached sustained virological suppression (SVR). A FibroScan determination was performed after a median time of 44.4 months (1-88). For initially cirrhotic patients, fibrosis improvement was observed in 35% (7/20), with a high rate of SVR associated (44% vs 23%; p=0.03). For less advanced stages, fibrosis regression or stabilization ranged from 43 to 52%; this group showed significantly higher values of SVR (43 vs 20%). After multivariate analysis, SVR (0.76) and therapy duration (0.88 per month) were associated with fibrosis regression, although SVR was not statistically significant (p=0.08) after adjusting by histological cirrhosis. A second FibroScan performed a median of 13.1 months after, showed similar results.
Conclusions: Our study showed the possibility of fibrosis improvement, demonstrated by FibroScan, in HCV/HIV coinfected patients after HCV therapy. This improvement seems to start early after therapy, and encourages the widespread use of HCV therapy in HCV/HIV coinfected.
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