Deferring HCV Tx increases morbidity and mortality risk

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Men who have sex with men co-infected with HIV and hepatitis C virus who deferred HCV treatment until evidence of advanced liver fibrosis appeared to have an increased risk for mortality and morbidity, Healio reports according to published findings.

“Our findings support current recommendations to start HCV treatment irrespective of fibrosis stage in those with risk factors for accelerated fibrosis progression, including HIV-co-infected (men who have sex with men), and in persons at elevated risk of HCV transmission,” Dr Andri Rauch, associate professor, department of infectious diseases, Bern University Hospital, Switzerland, and colleagues wrote.

The researchers developed an individual-based model of liver disease progression in men who have sex with men (MSM) with HIV/HCV co-infection enrolled in the Swiss HIV Cohort Study. Liver-related morbidity, mortality and median time of HCV replication when patients were treated in liver fibrosis stages F0, F1, F2, F3 or F4, based on the METAVIR scale.

Overall, 2% of patients died of liver-related complications when treatment was initiated in F0 or F1; 3% died if treatment was deferred until stage F2; 7% died when deferred until stage F3; and 22% died when treatment was deferred to stage F4.
Median time patients had with HCV replication increased from 5 years if treatment was initiated in stage F2 to about 15 years if treatment was deferred until stage F4.

“Our model predicts that the time individuals spend with replicating HCV can be greatly shortened by early treatment,” the researchers wrote. “This may decrease further HCV transmissions in those with high-risk behavior.”

The researchers concluded: “Deferring HCV therapy until advanced liver fibrosis is established could increase liver-related morbidity and mortality in HIV/HCV co-infected individuals, and substantially prolong the time individuals spend with replicating HCV infection.”

Abstract
Background and aims
Hepatitis C (HCV) is a leading cause of morbidity and mortality in people who live with HIV. In many countries, access to direct acting antiviral agents to treat HCV is restricted to individuals with advanced liver disease (METAVIR stage F3 or F4). Our goal was to estimate the long term impact of deferring HCV treatment for men who have sex with men (MSM) who are coinfected with HIV and often have multiple risk factors for liver disease progression.
Methods
We developed an individual-based model of liver disease progression in HIV/HCV coinfected men who have sex with men. We estimated liver-related morbidity and mortality as well as the median time spent with replicating HCV infection when individuals were treated in liver fibrosis stages F0, F1, F2, F3 or F4 on the METAVIR scale.
Results
The percentage of individuals who died of liver-related complications was 2% if treatment was initiated in F0 or F1. It increased to 3% if treatment was deferred until F2, 7% if it was deferred until F3 and 22% if deferred until F4. The median time individuals spent with replicating HCV increased from 5 years if treatment was initiated in F2 to almost 15 years if it was deferred until F4.
Conclusions
Deferring HCV therapy until advanced liver fibrosis is established could increase liver-related morbidity and mortality in HIV/HCV coinfected individuals, and substantially prolong the time individuals spend with replicating HCV infection.

Full Healio report
Journal of Hepatology abstract


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