Spanish research published in the online
edition of Clinical Infectious Diseases
shows the benefits of successful hepatitis C therapy for people co-infected
with HIV who have compensated liver cirrhosis. Achievement of a sustained
virological response (SVR) was associated with lower rates of progression to
decompensated cirrhosis and a lower risk of death.
“The results found in this study
demonstrate that SVR following HCV therapy reduces the risk of emerging hepatic
decompensation and occurrence of death due to any cause in HIV-infected
individuals with cirrhosis,” comment the authors.
Patients received dual therapy with
pegylated interferon and ribavirin. The authors suggest that all co-infected
people with compensated cirrhosis should be evaluated for therapy with
regimens that also include newly available direct-acting antiviral agents.
Infection with hepatitis C can lead to
hardening (fibrosis) or scarring (cirrhosis) of the liver. People are said to
have 'compensated cirrhosis' when their liver can still cope – or compensate –
for this scarring. People are diagnosed with decompensated cirrhosis when
they develop serious liver-related disease. Decompensated cirrhosis is
associated with a poor prognosis.
Little is known about the benefits of
hepatitis C therapy for co-infected people with compensated cirrhosis.
A team of Spanish investigators therefore
designed a prospective study involving 166 co-infected people with baseline
compensated cirrhosis who received hepatitis C therapy between 2001 and 2011.
Treatment consisted of pegylated interferon and weight-based ribavirin and
lasted 48 weeks.
The authors gathered data on the proportion
of people who achieved an SVR (undetectable hepatitis C viral load 24 weeks
after the completion of treatment, regarded as a cure). Over a median of 55
months of follow-up, rates of progression to decompensated cirrhosis and death
were compared between people who achieved an SVR and those who did not.
Overall, 25% of patients achieved an SVR. A
total of 25 people (21%) progressed to decompensated cirrhosis. The rate of
disease progression was 5 cases per 100 person-years.
Analysis of outcomes according to treatment
response showed that 5% of people with an SVR progressed to decompensated
disease compared to 27% of individuals without an SVR (p = 0.002). The rate of
disease progression was 0.89 per 100 person-years among those with an SVR,
compared to 6.4 per 100 person-years for people who did not respond to
The probabilities of developing
decompensated cirrhosis for people with an SVR one year and three years after
completing therapy were 0 and 4% respectively. The corresponding probabilities
for patients without an SVR were 15 and 32%.
After controlling for other factors
associated with liver disease progression, achievement of an SVR was confirmed
as reducing the risk of decompensated cirrhosis (p = 0.042).
However, an SVR did not significantly reduce
the risk of liver cancer. One patient with a treatment response developed
hepatocellular carcinoma (HCC), compared to four patients without an SVR. “We
cannot exclude that the association between SVR and a lesser incidence of HCC
did not reach statistical significance due to lack of statistical power and
insufficient follow-up,” write the authors. They recommend that co-infected
people with compensated cirrhosis “should be followed-up in the long-term,
and screening programmes for HCC should be continued, even after achieving
A total of 24 people (15%) died during
follow-up, including two (5%) who had an SVR and 22 (18%) without an SVR. The
mortality rate was 0.87 per 100 person-years for people with a treatment
response, versus 4.1 per 100 person-years for people without an SVR.
The probabilities of death for people
with an SVR one and three years after treatment were 0 and 3% respectively. The
corresponding probabilities for people without a treatment response were 12
and 20%. The association between an SVR and a reduced mortality risk was
confirmed in multivariate analysis (p = 0.043).
Overall, 10% of patients died because of
liver failure. SVR reduced the risk of liver-related deaths. The rate of
liver-related mortality for people with an SVR was 0.87 per 100 person-years
compared to a rate of 2.8 deaths per 100 person-years for people who did not
eradicate their hepatitis C infection.
“This study shows that the achievement of
SVR following peg-IFN plus RBV treatment is associated with a marked reduction
in the risk of hepatic decompensations and overall mortality in HIV-infected
patients with compensated HCV-related cirrhosis,” comment the investigators.
“Data from this study strongly support that therapy-driven HCV eradication is a
priority in HIV-infected individuals with compensated HCV-related cirrhosis in
order to prevent liver-related decompensation and mortality secondary to any
They conclude, “treating these patients
with the best treatment available for chronic HCV infection is a priority”.