Liver fibrosis regression in people living with HIV after successful treatment for hepatitis C
In the frame of the InCHEHC Collaboration, Young et al. assessed the extent of liver fibrosis regression after successful treatment of hepatitis C virus (HCV) infection in persons with HIV.
They included individuals with HIV/HCV who achieved sustained virologic response after a first course of all-oral direct acting antivirals (DAA). Individuals with chronic hepatitis B, those successfully treated with an interferon-based regimen and people in which an oral DAA regimen previously failed were excluded. Using a generalized additive mixed model, they analyzed liver fibrosis regression as determined by transient elastography (TE).
Of the 1,470 participants included, 250 (15%) had liver cirrhosis (F4) and 595 (35%) had significant fibrosis (F2-3) before treatment. Post-treatment TE measurements were available for 36% of the participants. In individuals with liver cirrhosis, the mean response curve showed a steep drop during treatment but remained afterwards. However, around 70% of those with cirrhosis pre-treatment were predicted to have a TE measurement >12 kPa after treatment. In contrast, almost all individuals with significant fibrosis before treatment were predicted to reach a TE measurement <12 kPa one year after treatment and the mean response curve dropped during treatment as well as in the first year after treatment.
In conclusion, the authors observed different patterns of liver fibrosis regression depending on the level of fibrosis before treatment: Individuals with cirrhosis were unlikely to experience a relevant fibrosis regression, whereas individuals with significant fibrosis usually achieved TE levels below fibrosis threshold. The findings support the recommendation to continue screening for hepatocellular carcinoma (HCC) in those with pre-treatment liver cirrhosis, but question the need for screening in individuals with ≤F3 pre-treatment.