From the Journals

Eradicate HCV in patients with HIV, regardless of fibrosis stage

Publish date: February 12, 2017

FROM HEPATOLOGY

Eradicating hepatitis C virus in HIV-coinfected patients was associated with a significantly lower risk of diabetes mellitus and possibly chronic renal failure, along with lower rates of deaths, HIV progression, and liver-related events, according to an observational study of 1,625 patients.

“These findings argue for the prescription of HCV therapy regardless of liver fibrosis stage in coinfected patients,” Juan Berenguer, MD, PhD, and his associates at Hospital General Universitario Gregario Marañón, Madrid. Extrahepatic manifestations of HCV infection are numerous and contribute substantially to morbidity and mortality. “To the best of our knowledge, the effect of eradication of HCV on extrahepatic manifestations of HCV has not been systematically studied in HIV/HCV-coinfected patients,” the researchers wrote in Hepatology (Hepatology 2017 Jan 21:doi:10.1002/hep.29071 [Epub ahead of print]).

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Their cohort included patients who were coinfected with HIV and HCV, were naïve to HCV therapy, and had no history of hepatic decompensation or severe concurrent medical conditions such as heart failure or poorly controlled hypertension. All patients underwent treatment with interferon and ribavirin. A total of 628 (38.6%) had a sustained viral response (SVR).

After a median of 5 years of follow-up, SVR was associated with a 43% decrease in the likelihood of developing diabetes, even after controlling for a host of potential confounders, including Fibrosis-4 score (using 3.25 as the cutoff value), age, sex, history of AIDS, HIV-transmission category, nadir CD4+ T-cell count, antiretroviral therapy, HIV-RNA, HCV genotype, and exposure to specific anti-HIV drugs (adjusted hazard ratio, 0.57; 95% confidence interval, 0.35 to 0.93; P = .02). Sustained viral response also was associated with a lower likelihood of chronic renal failure with borderline statistical significance (aHR, 0.43; 95% CI, 0.17 to 1.09; P = .075).

“In agreement with previous reports from this cohort, we found that treatment response was associated with a decreased hazard of overall and liver-related death, all types of liver-related events, and new AIDS-related conditions,” the researchers noted. These findings underscore the vital importance of HCV therapy for HIV-coinfected patients, regardless of liver fibrosis stage, they emphasized.

The study was funded by Spanish Health Research Funds and AIDS Research Network. The investigators reported having no relevant conflicts of interest.

Eradicate HCV in patients with HIV, regardless of fibrosis stage

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