Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.
Infectious Diseases Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain.
J Viral Hepat. 2019 Jan;26(1):16-24. doi: 10.1111/jvh.12990. Epub 2018 Sep 27.
Among patients with cirrhosis, recovery of liver function after SVR to all-oral direct-acting antivirals (DAA) in HIV/HCV coinfection could be different to that in HCV monoinfection. Because of this, we compared the changes in several markers of liver function between HCV-monoinfected and HIV/HCV-coinfected patients with cirrhosis who achieved SVR12 to DAA combinations. In this retrospective cohort study, cirrhotics included in the HEPAVIR-DAA and GEHEP-MONO cohorts were selected if they had SVR12 to all-oral DAAs. Patients treated with atazanavir were excluded. Liver function improvement was defined as Child-Pugh-Turcotte (CPT) decrease ≥1 and/or MELD decrease ≥2 between baseline and SVR12. Liver function worsening was defined as a CPT increase ≥1 and/or MELD increase ≥2 and/or decompensations between baseline and SVR12. We included 490 patients, 270 (55%) of them with HIV coinfection. Liver function improved in 50 (56%) HCV-infected individuals and in 82 (57%) HIV/HCV-coinfected patients (P = 0.835). Liver function worsened in 33 (15%) HCV-monoinfected patients and in 33 (13%) HIV/HCV-coinfected patients (P = 0.370). Factors independently related with liver function improvement were male gender [adjusted OR (AOR) 2.1 (95% confidence interval, 95% CI: 1.03-4.2), P = 0.040], bilirubin < 1.2 mg/dL (AOR 1.8 [95% CI: 1.004-3.3], P = 0.49), and INR < 1.3 (AOR 2.4 [95% CI: 1.2-5.0], P = 0.019) at baseline. After multivariate analysis, albumin < 3.5 g/dL was associated with liver function worsening (AOR 6.1 [95% CI: 3-12.5], P < 0.001). Liver function worsening and improvement rates after responding to DAA are similar among HCV-monoinfected and HIV/HCV-coinfected cirrhotics. Gender, INR, bilirubin, and albumin levels were associated with liver function changes after response to DAAs.
在合并感染 HIV 和 HCV 的肝硬化患者中，与 HCV 单感染患者相比，他们在接受所有口服直接作用抗病毒药物 (DAA) 治疗后肝功能的恢复可能不同。正因为如此，我们比较了在达到 DAA 联合治疗 SVR12 的 HCV 单感染和 HIV/HCV 合并感染的肝硬化患者中，几种肝功能标志物的变化。在这项回顾性队列研究中，HEPAVIR-DAA 和 GEHEP-MONO 队列中如果患者对所有口服 DAA 达到 SVR12，则选择肝硬化患者入选。排除接受阿扎那韦治疗的患者。肝功能改善定义为基线和 SVR12 之间的 Child-Pugh-Turcotte (CPT) 降低≥1 和/或 MELD 降低≥2。肝功能恶化定义为 CPT 增加≥1 和/或 MELD 增加≥2 和/或基线和 SVR12 之间的失代偿。我们纳入了 490 名患者，其中 270 名（55%）合并 HIV 感染。50 名（56%）HCV 感染患者和 82 名（57%）HIV/HCV 合并感染患者的肝功能改善（P=0.835）。33 名（15%）HCV 单感染患者和 33 名（13%）HIV/HCV 合并感染患者的肝功能恶化（P=0.370）。与肝功能改善相关的独立因素为男性（调整后的 OR [AOR] 2.1[95%置信区间，95%CI：1.03-4.2]，P=0.040），胆红素<1.2mg/dL（AOR 1.8[95%CI：1.004-3.3]，P=0.49），和基线时 INR<1.3（AOR 2.4[95%CI：1.2-5.0]，P=0.019）。多变量分析后，白蛋白<3.5g/dL 与肝功能恶化相关（AOR 6.1[95%CI：3-12.5]，P<0.001）。在对 DAA 有反应后，HCV 单感染和 HIV/HCV 合并感染肝硬化患者的肝功能恶化和改善率相似。性别、INR、胆红素和白蛋白水平与 DAA 治疗后肝功能变化相关。
