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

作者：Loko Marc Arthur^*; Bani Sadr Firouze; Valantin Marc Antoine; Lascoux Combe Caroline; Fontaine Helene; Bonnard Philippe; Gervais Anne; Bouchaud Olivier; Garipuy Daniel; Quertainmont Yann; Vittecoq Daniel; Tehrani Michka Shoai; Winnock Maria; Dabis Francois; Salmon Dominique

来源：Antiviral Therapy, 2012, 17(7): 1335-1343.

DOI：10.3851/IMP2419

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 (beta 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.

• 出版日期2012