Clinical effects of viral relapse after interferon plus ribavirin in patients co-infected with human immunodeficiency virus and hepatitis C virus

• Published in: Journal of hepatology 2013-06, Vol.58 (6), p.1104-1112
• Main Authors: Berenguer, Juan, Alvarez-Pellicer, Julio, Carrero, Ana, Von Wichmann, Miguel A, López-Aldeguer, José, Mallolas, Josep, Galindo, María J, Van Den Eynde, Eva, Téllez, María J, Quereda, Carmen, Tural, Cristina, Sanz, José, Barros, Carlos, Santos, Ignacio, Pulido, Federico, Guardiola, Josep M, Ortega, Enrique, Rubio, Rafael, Jusdado, Juan J, Montes, María L, Gaspar, Gabriel, Barquilla, Elena, Bellón, José M, González-García, Juan
• Format: Article
• Language: English
• Subjects: Adult; Alanine Transaminase - blood; Cohort Studies; Coinfection - drug therapy; Female; Follow-up studies; Gastroenterology and Hepatology; Hepatitis C chronic/complications/drug therapy; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - mortality; Hepatitis C, Chronic - virology; HIV Infections - mortality; HIV Infections - virology; HIV Infections/complications/drug therapy; Humans; Interferons - administration & dosage; Interferons/administration and dosage/therapeutic use; Liver - pathology; Male; Proportional Hazards Models; Ribavirin - administration & dosage; Treatment outcome
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2013.01.042

Background & Aims Sustained viral response (SVR) after therapy with interferon-ribavirin (IF-RB) reduces liver-related (LR) complications and mortality in HIV/HCV-co-infected patients. Here, we assess the impact of end-of-treatment response with subsequent relapse (REL) on LR events (LR death, liver decompensation, hepatocellular carcinoma, or liver transplantation), and liver stiffness (LS) by transient elastography. Methods We analyzed the GESIDA 3603 Cohort (HIV/HCV-co-infected patients treated with IF-RB in 19 centers in Spain). Response to IF-RB was categorized as SVR, REL, and no response (NR). The study started when IF-RB was stopped and ended at death or the last follow-up visit. Multivariate regression analyses were adjusted for age, sex, HIV category of transmission, CDC clinical category, nadir CD4+ cell count, HCV genotype, HCV-RNA viral load, and liver fibrosis. Results Of 1599 patients included, response was categorized as NR in 765, REL in 250 and SVR in 584. Median follow-up was more than 4 years in each group. Taking the group of patients with NR as reference, we found that the adjusted hazard ratios (95% confidence interval) of liver-related events (liver-related death, liver decompensation, hepatocellular carcinoma, liver transplantation) for patients with REL and for patients with SVR were 0.17 (0.05; 0.50) and 0.03 (0; 0.20), respectively. We also found that SVR was followed by less liver stiffness than both REL and NR. However, REL was associated with less liver stiffness than NR. Conclusions Best outcomes were achieved with an SVR. However, REL was associated with less LR mortality, decompensation, and liver stiffness than NR.