Chronic hep C treatment in HIV-infected patients with compensated liver cirrhosis

Chronic hep C treatment in HIV-infected patients with compensated liver cirrhosis

Sustained virological response was associated with HCV genotypes 2–3
Journal of Viral Hepatitis

The most recent issue of the Journal of Viral Hepatitis investigates treatment of chronic hepatitis C in HIV-HCV coinfected patients with compensated liver cirrhosis.
The greatest benefit of hepatitis C virus (HCV) therapy is seen in cirrhotics attaining sustained virological response.
However, concerns about toxicity and poorer responses often discourage treatment of cirrhotics.
This may be particularly relevant in HIV–HCV-coinfected patients, in whom progression of liver fibrosis is faster and treatment responses lower.

Dr Luz Martin-Carbonero and colleagues from Spain performed a retrospective analysis of HIV–HCV-coinfected patients who had received peginterferon–ribavirin therapy at their institution.

Individuals naïve for interferon in whom liver fibrosis had been assessed using elastometry within the year before being treated were chosen.

Response rates and toxicities were compared in cirrhotics and noncirrhotics.
Patients with previous liver decompensation were excluded.

Overall, the team found that 41 cirrhotics and 190 noncirrhotics entered the study.
Groups were similar in age, gender, HCV genotypes and baseline serum HCV-RNA.

The research team observed that sustained virological response occurred at similar rates in cirrhotic and noncirrhotics, either considered by intention-to-treat or as treated.

The researchers found that sustained virological response was associated with HCV genotypes 2–3 and lower serum HCV-RNA but not with cirrhosis.

The team noted that treatment discontinuations because of adverse events tended to be more common in cirrhotics than in noncirrhotics, but only severe thrombocytopenia was more frequent in cirrhotics than in non-cirrhotics.

Dr Martin-Carbonero's team concluded, "Response to peginterferon–ribavirin therapy is similar in HIV–HCV coinfected patients with and without liver cirrhosis."
"Therefore, treatment must be encouraged in all compensated cirrhotic patients, although closer monitoring and management of side effects, mainly thrombocytopenia, may be warranted."

J Viral Hep 2011: 18(8): 542–548
29 July 2011