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Regression of liver stiffness after sustained hepatitis C virus (HCV) virological responses among HIV/HCV-coinfected patients.
AIDS. 2015 Sep 10;29(14):1821-30.

The impact of a sustained virologic response on liver stiffness in HIV/HCV-coinfected patients was assessed in the ANRS CO13 HEPAVIH cohort. HIV/HCV-coinfected patients with documented sustained virologic response on anti-HCV treatment were evaluated if they had a pretreatment FibroScan value of ≥ 7.1 kPa (Metavir stage ≥ F2), and at least one post-treatment FibroScan value. The time required to achieve at least a 30% decrease in liver stiffness was analyzed by Kaplan–Meier estimates and with the use of Cox proportional hazards models.

Results: Among 98 patients treated for HCV infection with either pegylated interferon along with ribavirin (n=89) or protease inhibitor-based triple therapy (n=9), 53 patients (54%) had a sustained virologic response. Median follow-up was 45 months. The probability of achieving a 30% decrease in FibroScan values was 51% (95% confidence interval: 39–66) in patients with a sustained virologic response and 21% in non-responders (95% CI: 11–36) at 1 year, and 74% (61–86) and 28% (17–44) at 2 years, respectively. In the subgroup of 35 cirrhotic patients (pretreatment liver stiffness ≥ 12.5 kPa), 14 of 18 patients with a sustained virologic response and 3 of 17 non-responders had a fibrosis score < 12.5 kPa at the last follow-up examination. Multivariable analysis showed that sustained virologic response was independently associated with a ≥ 30% reduction in liver stiffness, both in the overall study group (hazard ratio: 5.77; 95% CI: 2.00–16.62; P=0.0012) and in cirrhotic patients (hazard ratio: 8.21; 95% CI: 2.15–31.34; P=0.0021).

This observational prospective study confirms that a sustained virologic response has a favorable impact on liver stiffness with a significant reduction in elastrometry values not only in patients with moderate fibrosis but also in those with cirrhosis. Only longer follow-up will clarify whether this decrease in liver stiffness corresponds to a fibrosis regression and whether it is correlated to a decrease risk of hepatocellular carcinoma, especially in patients with advanced disease and decompensated cirrhosis.

Expert's Commentary

« In our cohort, patients were followed every year with elastometry and non invasive several tests of fibrosis whatever the issue of HCV treatment. Although it was not possible to demonstrate a true histological regression of fibrosis after HCV cure, the improvement in a corresponding way of Elastometry with two not invasive tests results (APRI and FIB4) constitutes an indirect but strong argument for a real fibrosis regression. To be certain that this improvement was not due to a simple fluctuation in the tests, we selected a threshold > 30 % as significant. The improvement of these tests in cirrhotic patients is very encouraging. It remains to demonstrate that this improvement will continue with time and can arise whatever the fibrosis severity, allowing finally to suppress the risk of liver deaths in HIV/HCV coinfected, including those with severe cirrhosis »

Pr Dominique Salmon,
Maladies Infectieuses, Hôpital Cochin