Liver stiffness at the time of sustained virological response predicts the clinical outcome in HIV/HCV-coinfected patients with advanced fibrosis treated with direct-acting antivirals.

Abstract

BACKGROUND\nSome HCV-infected patients with sustained virological response (SVR) develops hepatic complications. Liver stiffness (LS) predicts clinical outcome in HIV-infected patients with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in HIV/HCV-coinfected patients with advanced fibrosis treated with direct-acting antivirals (DAA).\n\n\nMETHODS\n640 HIV/HCV-coinfected patients fulfilling the following criteria were included: i) Achieved SVR with DAA-including regimen; ii) LS ≥9.5 kPa before therapy and; iii) LS measurement available at SVR. The primary end-point was the occurrence of a liver complication -hepatic decompensation or hepatocellular carcinoma (HCC) - or requiring liver transplant after SVR.\n\n\nRESULTS\nDuring a median (Q1-Q3) follow-up of 31.6 (22.7-36.6) months, 19 (3%) patients reached the primary end-point. In the multivariate analysis, variables (subhazard ratio [SHR] [95% CI]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28-9.12]), pre-treatment CPT class B or C (62.5 [3.08-1246.42]) and MELD scores (1.37 [1.03-1.82]), CPT class B or C at SVR (10.71 [1.32-87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49-13.15]), FIB-4 index at SVR (1.39 [1.13-1.70]) and LS at SVR (1.05 [1.02-1.08] for 1 kPa increase). None out of 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant.\n\n\nCONCLUSIONS\nLS at the time of SVR after DAA therapy predicts the clinical outcome of HIV/HCV-coinfected patients with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.