Antiretroviral therapy and sustained virological response to HCV therapy are associated with slower liver fibrosis progression in HIV–HCV-coinfected patients: study from the ANRS CO 13 HEPAVIH cohort

Marc-Arthur Loko (1) , Firouze Bani-Sadr (2) , Marc-Antoine Valantin (3, 4) , Caroline Lascoux-Combe (5) , Hélène Fontaine (6) , Philippe Bonnard (7) , Anne Gervais (8) , Olivier Bouchaud (9) , Daniel Garipuy (10) , Yann Quertainmont (11) , Daniel Vittecoq (12) , Michka Shoai Tehrani (13) , Maria Winnock (1) , François Dabis (1) , Dominique Salmon (2)

1 Epidémiologie et Biostatistique [Bordeaux]
2 Service Maladies infectieuses et tropicales [AP-HP Hôpital Cochin]
3 Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH [Paris]
4 CHU Pitié-Salpêtrière [AP-HP]
5 Service de maladies infectieuses et tropicales [Saint-Louis]
6 Département d'hépatologie [CHU Cochin]
7 CHU Tenon [AP-HP]
8 Services de Maladies Infectieuses et Tropicales [CHU Bichat]
9 Service de maladies infectieuses et tropicales [CHU Avicenne]
10 HJD - Hôpital Joseph Ducuing - Varsovie [Toulouse]
11 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
12 Hôpital Paul Brousse
13 Service des Maladies infectieuses et tropicales [CHU Necker]

Background: The aim of this study was to describe changes in repeated liver stiffness (LS) measurements and to assess the determinants of increase in LS in HIV-HCV-coinfected patients. Methods: HIV-HCV-coinfected adults enrolled in the ANRS CO 13 HEPAVIH cohort, for whom two results of LS, evaluated over ≥24 months, were available. Patients with unreliable LS results were not included. LS was measured at baseline and every year thereafter. Determinants of LS increase were assessed using linear (primary outcome: last LS minus first LS value) and logistic (secondary outcome: ≥30% increase in the initial LS value) regression analyses. Results: A total of 313 patients (mean age 45 years, 67.4% male) were included. Overall, 93.9% were receiving antiretroviral treatment (ART). The mean baseline CD4(+) T-cell count was 471 cells/mm(3) and 72.2% of patients had undetectable plasma HIV RNA. The mean interval between the first and last LS measurements was 33.5 months. No significant difference was found between baseline and follow-up mean LS values (P=0.39). However, a decrease of ≥30% in LS was observed in 48 (15.3%) patients and an increase of ≥30% in 64 (20.5%) patients. In multivariate linear and logistic analyses, excessive alcohol intake (β coefficient 6.8; P=0.0006) and high HCV viral load (OR 1.7, 95% CI 1.1, 2.5; P=0.01) were independently associated with an increase in LS, whereas time on ART>114.5 months (OR 0.5, 95% CI 0.3, 0.9; P=0.03) and achievement of sustained virological response (OR 0.1, 95% CI 0.01, 0.9; P=0.04) were independently associated with no increase in LS. Conclusions: Our findings show that long-term ART and achieving sustained virological response in HIV-HCV-coinfected patients are both significantly associated with lack of increase in LS over a 33-month period.

Domaines: Sciences du Vivant [q-bio]

Marc-Arthur Loko, Firouze Bani-Sadr, Marc-Antoine Valantin, Caroline Lascoux-Combe, Hélène Fontaine, et al.. Antiretroviral therapy and sustained virological response to HCV therapy are associated with slower liver fibrosis progression in HIV–HCV-coinfected patients: study from the ANRS CO 13 HEPAVIH cohort. Antiviral Therapy, 2012, 17 (7), pp.1335-1343. ⟨10.3851/IMP2419⟩. ⟨hal-03609500⟩