HIV: immediate antiretroviral therapy lowers the risk for liver fibrosis

  • Dharan NJ & al.
  • Hepatology
  • 8 Oct 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Significant liver fibrosis was rare in antiretroviral therapy (ART)-naïve HIV-positive persons with high CD4 counts.
  • Immediate ART was associated with lower risk for liver fibrosis vs deferred treatment.

Why this matters

  • The findings support current guidance to initiate ART in all patients with HIV irrespective of the CD4 count, particularly considering that modern ART regimens have a lower risk for hepatotoxicity.

Study design

  • START study: 4580 ART-naïve HIV-positive persons with high CD4 counts (>500 cells/μL) received immediate ART (2273) or deferred treatment when their CD4 count was
  • Outcomes: fibrosis (AST to platelet ratio index [APRI]>0.5 or fibrosis-4 index [FIB-4]>1.45), significant fibrosis (APRI>1.5 or FIB-4>3.25), hepatic flare and resolution of elevated APRI and FIB-4 scores.
  • Funding: National Institute of Allergy and Infectious Diseases; National Institutes of Health Clinical Center; National Cancer Institute, National Heart, Lung, and Blood Institute; others.

Key results

  • At baseline, confirmed significant fibrosis (APRI>1.5 and FIB-4>3.25) was reported in 1.1% of the patients by either APRI or FIB-4 and 0.3% of patients by both APRI and FIB-4.
  • Median CD4 count was 651 cells/mm3.
  • Immediate ART group participants were at lower risk of developing increased fibrosis scores than deferred group participants (HR, 0.66; P<.001>
  • By both APRI and FIB-4, liver fibrosis markers normalised faster among those in the immediate ART group vs the deferred therapy ART group (HR, 1.58; P
  • Among participants with APRI>0.5, normalisation occurred at a higher rate in the immediate vs deferred group (56.6 vs 40.9 per 100 person-years; HR, 1.63; P<.001>
  • Among participants with FIB-4>1.45, normalisation rates were higher in the immediate vs deferred group (40.6 vs 27.1 per 100 person-years; HR 1.62; P<.001>

Limitations

  • Findings cannot be generalised to persons with lower CD4 counts or viral hepatitis coinfection.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit