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Liver fibrosis regression after anti HCV therapy and the rate of death, liver-related death, liver-related complications, and hospital admissions in HIV / HCV coinfected patients with cirrhosis
J.L. Casado, S. Bañon, C. Quereda, A. Moreno, M.J. Perez-Elías, S. Moreno
Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
Session TUAB 02HCV: The Good News ContinuesAbstract TUAB 0204
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Introduction• Cumulative evidence demonstrates that SVR is associated
with a lower rate of death and liver related complications1,2. However, in spite of a lower risk, patients with cirrhosis are not entirely protected against the development of liver complications or HCC after SVR3,4.
• We and others have found an important rate of fibrosis regression (FR) during the follow-up of HIV/HCV-co-infected patients with SVR5.
• In hypothesis, FR after SVR in patients with cirrhosis should be associated with even a lower risk of hepatic complications, and a prolonged survival.
1Mira JA, et al. Clin Infect Dis 2013;56:1646-1653. 2Berenguer J, et al. Hepatology. 2009;50:407-413 3Merchante et al. Clin Infect Dis 2013;56:143-150; 4Aleman S et al. Clin Infect Dis 2013;57:230-236.5Casado JL, et al. J Viral Hepat 2013;20:829-837.
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Objective
• To determine the impact of FR and/or SVR on the clinical outcome of HIV/HCV co-infected patients with cirrhosis, in terms of:
– Overall death, – Liver-related death, and – Liver-related complications
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Methods (I)• Observational cohort study at the Hospital
Ramón y Cajal, in Madrid.
• Inclusion criteria:– All HIV/HCV coinfected patients who received therapy
with pegylated interferon and ribavirin since 2004– Baseline liver biopsy or transient elastography (TE)– Followed up by TE beginning in 2006.
• Fibrosis regression was defined as a confirmed reduction of at least one point in Fibrosis Metavir Score during the follow-up, without worsening in a successive TE, if available.
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Methods (II)• Primary end-points were death from any cause
and liver-related death. – The time to the event was the length of time since the end
of antiviral therapy until the primary endpoint.
• Secondary end-points were the development of a liver-related complication (ascites, encephalopathy, GI bleeding, HCC) and the number of hospital admissions. – Liver transplantation was considered as a liver-related
endpoint.
• For patients who did not die or were not transplanted, the analysis was censored at July 2014.
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Methods (III)
• Cumulative incidence curves of liver mortality and liver-related complications according to response and fibrosis regression were plotted using the Kaplan-Meier method. The differences between groups were assessed using log-rank tests.
• A multivariate Cox model was used to assess the independent effect of variables on the development of events during the follow-up.
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Baseline characteristics
1 92 patients with baseline liver biopsy2 41 patients with baseline TE
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SVR, Fibrosis Regression and Outcomes
TE, transient elastography; L-R, liver related; IR, incidence rate
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Overall Death and Liver-related Death according to SVR/FR
Liver- related death
Overall death
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Overall Death and Liver-related Death according to SVR and FR
Overall death Liver- related death
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Conclusions
• Our study clarifies the risk of complications after therapy in HIV-infected patients with cirrhosis, showing a lower rate if fibrosis regression is attained in addition to SVR.
• Moreover, we demonstrate that the histological benefit is clearly associated with the lowest risk of any-cause death, liver-related death, and hospital admissions.
• Of clinical application, LSM is useful in demarcating cirrhotic patients at a high risk for complications after therapy, and who would require a more frequent check-up. Sequential LSM after therapy could be useful in the management of the patients, irrespective of achieving SVR.