Risk of liver decompensation assessed in HIV/HCV co‐infected individuals with advanced liver fibrosis: a faster countdown experience

• DOI: 10.7448/ias.17.4.19641
• Publication Date: 2014-11-03T08:30:34Z
• Authors: Joao Pedro Alves; Susana Peres; Fernando Borges; Ana Cláudia Miranda; Teresa Baptista; Fernando Ventura; Isabel Antunes; Jaime Nina; Maria José Campos; Isabel Aldir; Kamal Mansinho
• Keywords: Decompensation; Liver disease; Hepatitis C

Cirrhosis secondary to HCV infection is expected peak in the next decade, particularly HIV co-infected subgroup and has become a leading cause of morbidity among these individuals. Efforts must be done estimate risk liver decompensation (LD) short term, order define appropriate time for treatment.Retrospective observational cohort study aimed assess LD group HIV/HCV patients diagnosed past 23 years central hospital Lisbon.(1) advanced fibrosis ≥F3; (2) treatment naïve or without sustained virologic response (SVR). Patients had one five period follow-up. Multiple linear regression, Mann-Whitney Kendall were statistical tests performed.From 444 co-infections, 66 met inclusion criteria, with preponderance male gender (82%), 35-45 age (55%), genotype 1a (52%), mean 13 co-infection an AIDS stage documented 65%, though majority under antiretroviral therapy (86%) have TCD4+>500 µ/L (59%). Half (52%) showed evidence steatosis, many (41%) presenting history alcoholism overweight (BMI ≥25 Kg/m(2)). Pre-cirrhotic (F3 F3/4) cirrhotic (F4) was 36 30 respectively. After staging, 28 (42%) initiated SVR achieved 8 (29%) those. Five (14%) pre-cirrhotic twelve (40%) experienced at least episode: vs cumulative events 2.8 1.8 average up first episode cirrhotic. The probability remaining free 97% 78% (p≤0.01) year; 88% 65% (p≤0.001) three 71% 44% years. Positive correlation found between (vs pre-cirrhosis, p≤0.001), baseline AST ≥100 <100 µ/L, p≤0.01) platelet count <120 x 109/L >120 109/L, p≤0.05).Cirrhosis accounts significant superior LD. event differed only year cirrhotic, standing importance rapid referral both subgroups. Modifiable factors that accelerate are prevalent patients. Low count, elevated F4 predict progression need early treatment. Large studies required further support results.