P0838 : Progression to advanced liver fibrosis in HIV/HCV-coinfected patients and prioritization of new hepatitis C therapies

Background: Because of its high cost, the use of direct-acting antivirals (DAA) is being restricted by many governments to chronic hepatitis C virus (HCV)infected individuals with advanced liver fibrosis. However, response rates are lower and toxicities more frequent in this subset of patients. Methods: All HCV/HIV-coinfected patients followed for at least 3 years at one reference clinic were identified. Liver fibrosis progression (LFP) was defined as a shift from Metavir F0-F2 to F3-F4 estimates (>9.5 KPa) using elastometry. Results: A total of 527 HIV/HCV-coinfected patients were identified, of whom 344 had F0-F2 at baseline. Peginterferon-ribavirin therapy was given to 205 patients with null-mild fibrosis, of whom 92 (44.9%) achieved sustained virological response (SVR). After a mean follow-up of 53 months, LFP occurred in 5.4% SVR, 25.7% non-SVR and 18% untreated patients (p=0.005). In multivariate analysis, only achievement of SVR prevented from LFP (adjusted hazard ratio 2.1; 95% confidence interval 1.1-4.1; p=0.01). In 139 untreated patients, only greater baseline elastometry values predicted LFP in multivariate analysis (aHR 1.84; 95% CI: 1.03-3.3; p=0.03). The area under the receiver operating characteristic (AUROC) curve was 79%. A discriminant threshold of 7.1 KPa gave 68% sensitivity and 82% specificity. Conclusions: In the absence of successful treatment, more than 20% of HIV/HCV-coinfected patients with null-mild liver fibrosis progress to advanced fibrosis within 5 years. Patients with >7.1 KPa (Metavir F2) display the highest risk. Therefore, all coinfected patients with any significant liver fibrosis should be considered as candidates for new DAA-based therapies. Accepted 28 April 2014, published online 25 June 2014