DAA Effect on Liver Stiffness in HCV/HIV Coinfection vs HCV Monoinfection

The regression of liver stiffness after successful treatment with direct-acting antiviral (DAA) regimens did not differ between patients with hepatitis C virus (HCV) monoinfection and patients with HCV/human immunodeficiency virus (HIV) coinfection, according to study results published in HIV Medicine.¹

HIV coinfection is known to negatively affect the course of chronic HCV infection, with faster progression of liver fibrosis, earlier transition to cirrhosis, and higher risk for developing decompensated liver disease compared with HCV-monoinfected patients.² While DAAs are highly effective in treating chronic HCV,^3-5 little is known about their effect in patients with HCV/HIV coinfection. Thus, researchers investigated the regression of liver stiffness in 129 patients coinfected with HCV/HIV compared with 85 patients with HCV monoinfection after successful DAA treatment and aimed to identify factors associated with liver stiffness regression.¹ 

Liver stiffness was assessed using transient elastography before the initiation and after the end of treatment, which was a median of 12 weeks. They found that there was no difference between patients who were monoinfected and those who had coinfection, and significant (≥30%) regression of liver stiffness was achieved in 45% of patients. Prior HCV treatment was a negative predictor of liver stiffness regression (P =.001), while a higher baseline transient elastography value was positively associated with achieving significant regression (P =.02). However, HIV coinfection status, HCV genotype, age, sex, treatment duration, controlled attenuation parameter value, bilirubin concentration, platelet count, and aspartate aminotransferase concentration were not associated with liver stiffness regression.

“Our data demonstrate the beneficial effects of DAA-based treatment regimens on liver stiffness in both HCV-monoinfected and HCV/HIV-coinfected patients,” concluded the investigators.¹

References

1. Malin JJ, Boesecke C, Schwarze-Zander C, et al. Liver stiffness regression after successful hepatitis C treatment is independent of HIV coinfection [published online January 27, 2019]. HIV Med. doi:10.1111/hiv.12705
2. Mandorfer M, Schwabl P, Steiner S, Reiberger T, Peck-Radosavljevic M. Advances in the management of HIV/HCV coinfection. Hepatol Int. 2016;10:424-435.
3. Sulkowski MS, Gardiner DF, Rodriguez-Torres M, et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. 2014;370:211-221.
4. Afdhal N, Zeuzem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370:1889-1898.
5. Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370:1483-1493.