Coinfection

Treatment of HIV/HCV Coinfected People with Compensated Liver Cirrhosis

HIV positive people with compensated liver cirrhosis related to chronic hepatitis C virus (HCV) responded as well to treatment with pegylated interferon and ribavirin as coinfected patients without cirrhosis, but they should receive closer monitoring and may need more intensive management of side effects.

As described in the August 2011 Journal of Viral Hepatitis, Luz Martin-Carbonero and colleagues retrospective analyzed HIV/HCV coinfected patients who were treated with pegylated interferon/ribavirin at Hospital Carlos III in Madrid, Spain.

The greatest benefit of hepatitis C treatment is seen in people with cirrhosis who achieve sustained virological response (SVR), the study authors noted as background. But concerns about drug toxicity and poor responses can discourage treatment. This may be especially true for HIV/HCV coinfected patients, who typically experience more rapid liver fibrosis progression and do not respond as well to interferon-based therapy.

The study included 41 previously untreated coinfected cirrhotic patients and 190 coinfected participants without cirrhosis at baseline. Liver disease was assessed using transient elastometry (FibroScan) within 1 year before starting treatment (cut-off for cirrhosis was > 14.5 KPa). People with previous liver decompensation were excluded. Participants with and without cirrhosis were similar with regard to age, sex, HCV genotype, and baseline HCV RNA viral load.

Results

• Patients with and without liver cirrhosis had similar likelihood of achieving SVR:
  • Intention-to-treat analysis: 39%vs 45%, respectively (P = 0.4);
  • As-treated analysis: 50% vs 52%, respectively (P = 0.8).
• In a multivariate analysis, SVR was significantly associated with HCV genotype 2 or 3 and lower baseline HCV RNA, but not with cirrhosis.
• Treatment discontinuation due to adverse events tended to be more common in cirrhotic patients than in patients without cirrhosis (17% vs 12%), but the difference did not reach statistical significance (P = 0.2).
• Only severe thrombocytopenia (low platelet count) was significantly more common in cirrhotic patients compared with non-cirrhotics (20% vs 3% at week 24; P < 0.01).

Based on these findings, the study authors concluded, "Response to peginterferon/ribavirin therapy is similar in HIV/HCV coinfected patients with and without liver cirrhosis."

Therefore, they recommended, "treatment must be encouraged in all compensated cirrhotic patients, although closer monitoring and management of side effects, mainly thrombocytopenia, may be warranted."

8/12/11

Reference

L Martin-Carbonero, P Tuma, E Vispo, et al. Treatment of chronic hepatitis C in HIV-infected patients with compensated liver cirrhosis. Journal of Viral Hepatitis18(8): 542-548 (abstract). August 2011.