Fabbri G, Mastrorosa I, Vergori A, Timelli L, Lorenzini P, Zaccarelli M, Cicalini S, Bellagamba R, Plazzi M M, Mazzotta V, Antinori A, Ammassari A
Clinical Department, HIV/AIDS Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
HIV Med. 2018 Jun 28. doi: 10.1111/hiv.12632.
Only a few studies have addressed liver stiffness dynamics after hepatitis C virus (HCV) treatment in patients with HIV/HCV coinfection. The aim was to evaluate the variation in liver stiffness and in serum liver fibrosis scores in HIV/HCV-coinfected patients before and after treatment with direct-acting antivirals (DAAs).
Liver stiffness measured using transient elastography as well as serum liver fibrosis scores [fibrosis-4 (FIB-4) score and the aspartate aminotransferase to platelet ratio index (APRI)] were evaluated before and at 6-12 months after DAA treatment. Variation in the outcome variables was evaluated using the Wilcoxon nonparametric test. Univariate analysis and multivariate regression models were used.
A total of 78 HIV/HCV-coinfected subjects were included in the study. Median values of hepatic stiffness significantly decreased after DAA treatment compared with baseline [16.8 (interquartile range (IQR) 10.2-27.0) kPa at baseline vs. 9.4 (IQR 6.7-15.0) kPa after DAA treatment; P < 0.01). Further, a decrease in median FIB-4 score [2.8 (IQR 1.5-4.8) vs. 2.0 (IQR 1.3-3.2), respectively; P < 0.01] and APRI [0.9 (IQR 0.5-2.2) vs. 0.4 (IQR 0.2-0.7), respectively; P < 0.01] was found. In univariate analysis, liver stiffness decrease was associated with increasing age, 'other' HCV genotype (vs. G1), the presence of cirrhosis, higher pre-DAA liver stiffness, sofosbuvir-based regimens and longer DAA treatment (all P < 0.05). Multivariate regression confirmed the significance of the association only with higher baseline liver stiffness (P < 0.01). Greater FIB-4 and APRI reductions were associated with higher respective baseline values, while the presence of hepatic steatosis correlated with lower score reduction after DAA.
A reduction in liver stiffness and an improvement in fibrosis scores were observed in HIV/HCV-coinfected patients soon after DAA treatment. The clinical implications of these observations need to be evaluated in larger populations with longer follow-up.
仅有少数研究探讨了HIV/丙型肝炎病毒（HCV）合并感染患者在HCV治疗后的肝脏硬度动态变化。本研究旨在评估接受直接抗病毒药物（DAA）治疗的HIV/HCV合并感染患者治疗前后肝脏硬度及血清肝纤维化评分的变化。
采用瞬时弹性成像技术测量肝脏硬度，并在DAA治疗前及治疗后6 - 12个月评估血清肝纤维化评分[纤维化-4（FIB-4）评分和天冬氨酸转氨酶与血小板比值指数（APRI）]。使用Wilcoxon非参数检验评估结果变量的变化。采用单因素分析和多因素回归模型。
本研究共纳入78例HIV/HCV合并感染的受试者。与基线相比，DAA治疗后肝脏硬度的中位数显著降低[基线时为16.8（四分位间距（IQR）10.2 - 27.0）kPa，DAA治疗后为9.4（IQR 6.7 - 15.0）kPa；P < 0.01]。此外，FIB-4评分中位数降低[分别为2.8（IQR 1.5 - 4.8）和2.0（IQR 1.3 - 3.2）；P < 0.
