Liver function improved following eradication of hepatitis C virus (HCV) among a majority of patients with cirrhosis, according to a team of Italian investigators. Findings from their multicenter cohort study of 1350 patients were published in BMC Infections Diseases.
The study goal was to compare liver function changes between coinfected and monoinfected patients with cirrhosis who achieved HCV eradication following treatment with direct-acting antiviral (DAA) agents.
Patients were recruited from the Italian Platform for the study of viral hepatitis therapy (PITER) between 2015 and 2019. Patients with cirrhosis and HCV (n=1242) or HCV/HIV (n=108) coinfection who had a sustained viral response for 12 weeks after DAA therapy were assessed for liver function and clinical outcomes.
The median ages of patients in the monoinfected vs coinfected cohorts were 64.0 years and 52.5 years, respectively (P <.001). In the monoinfected vs coinfected groups, 58.1% vs 81.5% were men (P <.001), median alanine aminotransferase levels were 74.0 IU/L and 63.0 IU/L (P =.01), and 9.5% vs 27.1% were current users of alcohol (P <.001), respectively.
HCV genotype 1b was most prevalent in the monoinfected group (53.5%). HCV genotypes 1a (30.6%) and 3 (28.7%) were more prevalent in the coinfected group (P <.001).
HIV coinfection was associated with increased Child-Pugh class B/C disease compared with class A disease (adjusted odds ratio [aOR], 3.73; 95% CI, 2.00-6.98).
Median follow-up duration was 24.7 months (range, 6.8-47.5) and 27.1 months (range, 6.0-44.6) after DAA therapy to achieve HCV eradication in the monoinfected vs coinfected groups, respectively. Child-Pugh class improved in 85% of coinfected patients (from B to A and from C to B) and in 64.6% of monoinfected patients (from B to A) (P =0.08). The Child-Pugh class of some patients worsened (8.2% vs 5.3%, respectively). Decompensating events occurred among 4.8% of monoinfected and 4.3% of coinfected patients with no history of events and among 45.8% of monoinfected and 46.6% of coinfected patients with a history of decompensation, respectively.
Child-Pugh class worsening after DAA therapy was associated with increasing international normalizing ratio (adjusted hazard ratio [aHR], 2.41; 95% CI, 1.51-3.84), male sex (aHR, 2.00; 95% CI, 1.18-3.36), and low platelet count (<100,000/mL; aHR, 1.75; 95% CI, 1.08-2.85).
This study was limited by its small sample size and imbalanced cohort characteristics, the investigators wrote.
The authors concluded that their results indicate many patients, especially those with worse Child-Pugh liver disease class, had improved liver function after the eradication of HCV.
Quaranta MG, Ferrigno L, Tata X, et al. Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort. BMC Infect Dis. 2021;21(1):413. doi:10.1186/s12879-021-06053-3