In HIV-HCV–Coinfected Patients, How to Avoid Hepatic Decompensation?

Patients coinfected with hepatitis C virus (HCV) and HIV can develop rapidly progressive liver fibrosis.¹ End-stage liver disease is the most common cause of death in these patients even when they are undergoing antiretroviral therapy.² In this context, treatment directed against HCV has the potential to reduce the risk of liver events in this vulnerable population.

Recently, a study published in the journal Clinical Infectious Diseases aimed to assess the risk of decompensation among HIV-infected individuals with chronic HCV infection and advanced liver fibrosis.³ The retrospective cohort study included patients with HIV and HCV coinfection seen at 11 tertiary centers in Spain. Liver fibrosis was assessed by liver biopsy or by hepatic transient elastography (LSM). The median follow-up of these patients was 5.4 years.

For patients with liver biopsies, the probability of remaining free of liver decompensation was 99% (95% CI, 96%-100%) at 1 year; 95% (95% CI, 92%-97%) at 3 years; and 90% (95% CI, 85%-93%) at 5 years. Liver fibrosis stage was the only variable independently associated with liver decompensation on multivariate analysis. The probability of staying free of liver decompensation was 95% (95% CI, 93%-97%) at 1 year; 83% (95% CI, 79%-87%) at 3 years; and 77% (95% CI, 72%-82%) at 5 years.³  In both groups, stage 4 liver fibrosis or cirrhosis, vs stage 3 or pre-cirrhosis, was associated with greater risk of hepatic deterioration; in the LSM group, a platelet count ≤100,000/µL was independently associated with higher risk.³

This study showed that HIV-HCV–coinfected patients with advanced fibrosis, even without cirrhosis, are still at risk for liver decompensation in the short term. These results suggest that immediate therapy for HCV infection should be considered for these patients to avoid deterioration within 1 to 3 years after the initial diagnosis.³

Primary care physicians treating patients with HIV-HCV coinfection who have advanced fibrosis should be attentive to the high risk of hepatic events in the short term and could consider referral for early treatment of HCV infection.

References:

1. Macas J, Berenguer J, Japn MA, et al. Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus. Hepatology. 2009;50:1056-1063.

2. Pineda JA, Garca-Garca JA, Aguilar-Guisado M, et al. Clinical progression of hepatitis C virus-related chronic liver disease in human immunodeficiency virus-infected patients undergoing highly active antiretroviral therapy. Hepatology. 2007;46:622-630.

3. Macas J, Mrquez M, Tllez F, et al. Risk of liver decompensation among HIV/hepatitis C virus-co-infected individuals with advanced fibrosis: implications for the timing of therapy. Clin Infect Dis. 2013;57:1401-1408. doi:10.1093/cid/cit537.