HCV/HIV: LSM >12 kPa tied to early death independent of SVR

  • Shili-Masmoudi S & al.
  • PLoS One
  • 1 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Liver stiffness measurement (LSM) >12.5 kPa at any time point predicts >3-fold increased risk for all-cause mortality in patients with HCV/HIV coinfection, regardless of sustained virologic response (SVR).

Why this matters

  • Findings support need for close monitoring after SVR.

Study design

  • Study of 1062 HCV/HIV coinfected participants (median age, 45.7 years; 69.8% men) with ≥1 LSM in the 2005-2015 French ANRS CO13 HEPAVIH nationwide prospective cohort.
  • 21.7% had baseline LSM  >12.5 kPa.
  • Median follow-up, 4.9 years.
  • Funding: French national agency for HIV and hepatitis research (ANRS).

Key results

  • 68.5% received HCV treatment, and 26.0% achieved SVR.
  • 76 deaths occurred, including 26 liver-related deaths; cumulative mortality incidence at ages 50, 60, and 70 years was 5.9%, 13.4%, and 25.5%, respectively.
  • Across age groups, overall and liver-related mortality were higher with LSM >12 kPa vs ≤12.5 kPa.
    • e.g., age 50 years: 10.8% vs 4.5% and 6.8% vs 0.14%; both P<.001.>
  • In multivariate analysis, LSM >12 kPa was tied to increased all-cause mortality (aHR=3.35; P<.001 independent of svr age alcohol use metabolic disorders and prior hcv treatment.>
  • History of treatment had a protective effect (aHR=0.53; P=.017), past/present smoking worsened risk (aHR=5.69 and 3.22; P=.015).

Limitations

  • Conducted before direct-acting antiviral era.
  • Lifestyle factors self-reported.

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