Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville.
Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo.
AIDS. 2019 Jun 1;33(7):1167-1174. doi: 10.1097/QAD.0000000000002186.
To assess the impact of HIV coinfection on the risk of developing liver-related complications in HCV-infected patients with advanced fibrosis treated with direct-acting antivirals (DAA) after sustained virological response (SVR).
Prospective cohort study.
Multicenter.
Patients from the GEHEP and HEPAVIR cohorts were selected if they fulfilled the following criteria: treatment against HCV with all oral DAA combination; SVR achievement, defined as undetectable plasma HCV RNA 12 weeks after the end of therapy; pretreatment liver stiffness equal to or higher than 9.5 kPa; liver stiffness measurement at the time of SVR.
MAIN OUTCOME MEASURE(S): The primary variable was the time until the development of a liver complication or requiring liver transplant.
Seven hundred and seventeen patients were included and 507 (71%) were coinfected with HIV. After a median follow-up time of 21 (14-25) months, 15 (2.1%) patients developed a liver complication and/or underwent a liver transplant and 15 (2.0%) died. The probability of remaining free of hepatic complications or transplant at 1 and 2 was, respectively, 99 and 96% in HCV-monoinfected patients and 99 and 98% in coinfected patients (P = 0.648). In a multivariate analysis, in which nonliver-related death was considered as a competing event, HIV coinfection was not associated with the appearance of hepatic complications or requiring liver transplant [hazard ratio = 0.24; 95% CI (0.03-1.93), P = 0.181]. Having presented hepatic decompensation prior to SVR [hazard ratio = 29.06; 95% CI (3.91-216.16), P < 0.001] and the value of liver stiffness at the SVR time-point (hazard ratio = 1.12; 95% CI (1.07-1.18), P < 0.001] were associated with a higher probability of development of liver events.
HIV coinfection is not associated with a higher probability of developing liver complications in HCV-infected patients with advanced fibrosis, who achieved SVR with interferon-free regimens.
评估 HIV 合并感染对接受直接作用抗病毒药物（DAA）治疗后获得持续病毒学应答（SVR）的 HCV 感染且伴有晚期纤维化患者发生肝脏相关并发症风险的影响。
前瞻性队列研究。
多中心。
符合以下标准的来自 GEHEP 和 HEPAVIR 队列的患者入选：接受所有口服 DAA 联合治疗抗 HCV；获得 SVR，定义为治疗结束后 12 周时不可检测的血浆 HCV RNA；治疗前肝硬度等于或高于 9.5 kPa；在 SVR 时进行肝硬度测量。
主要变量是发生肝脏并发症或需要进行肝移植的时间。
717 例患者入选，其中 507 例（71%）合并 HIV 感染。中位随访时间为 21（14-25）个月后，15 例（2.1%）患者发生肝脏并发症和/或进行了肝移植，15 例（2.0%）患者死亡。HCV 单感染患者在 1 年和 2 年时无肝脏并发症或肝移植的概率分别为 99%和 96%，而合并感染患者的概率分别为 99%和 98%（P=0.648）。在多变量分析中，将非肝脏相关死亡视为竞争事件，HIV 合并感染与出现肝脏并发症或需要肝移植无关[风险比=0.24；95%CI（0.03-1.93），P=0.181]。在获得 SVR 之前出现肝脏失代偿[风险比=29.06；95%CI（3.91-216.16），P<0.001]和 SVR 时的肝硬度值[风险比=1.12；95%CI（1.07-1.18），P<0.001]与发生肝脏事件的概率较高相关。
在获得无干扰素治疗方案的 SVR 的 HCV 感染且伴有晚期纤维化患者中，HIV 合并感染与发生肝脏并发症的概率增加无关。
