The online version of this article (doi: 10.1007/s00508-017-1231-x) contains supplementary material, which is available to authorized users.
Hepatitis C virus (HCV) therapy should be considered without delay in all patients with significant (SIGFIB) or advanced liver fibrosis (ADVFIB). We aimed to investigate the rates of treatment initiation with interferon-free regimens within a screening program for SIGFIB/ADVFIB in human immunodeficiency virus/HCV coinfected patients (HIV/HCV).
The FIB-4 was calculated in all HIV/HCV from 2014–2016. HIV/HCV were counselled by the HIV clinic and referred to the Division of Gastroenterology and Hepatology for transient elastography (TE) and evaluation for HCV therapy. Patients were stratified by FIB-4 of </≥1.45 (established cut-off for ruling out ADVFIB) and SIGFIB/ADVFIB were defined by liver stiffness >7.1 kPa/>9.5 kPa, respectively.
Among 1348 HIV+ patients, 16% (210/1348) had detectable HCV-RNA. One hundred HIV/HCV had a FIB-4 ≥1.45. Among these, 57% (57/100) underwent TE. The majority of these patients had SIGFIB (75%; 43/57) or ADVFIB (37%; 21/57), however, interferon-free treatment was initiated in only 56% (24/43).
In addition, fifty-two percent (57/110) of HIV/HCV with FIB-4 <1.45 underwent TE. Interestingly, 40% (23/57) and 18% (10/57) of these patients showed SIGFIB or even ADVFIB, respectively, and 78% (18/23) finally received interferon-free treatment. Overall, only 20% (42/210) of HIV/HCV received interferon-free treatment.
FIB-4 was not useful for ruling out SIGFIB/ADVFIB in our cohort of HIV/HCV. Treatment was initiated only in a small proportion (20%) of HIV/HCV during the first 2 years of interferon-free treatment availability, although the observed proportion of patients with SIGFIB (assessed by TE) was considerably higher (58%). Thus, it requires the ongoing combined efforts of both HIV and HCV specialists to increase treatment uptake rates in this special population.
Supplementary Table 1 Comparison of all HIV/HCV coinfected patients with FIB-4 <1.45 and ≥1.45508_2017_1231_MOESM1_ESM.docx
Smith C, Sabin CA, Lundgren JD, Thiebaut R, Weber R, Law M, et al. Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D study. AIDS. 2010;24(10):1537–48. PubMed
Sulkowski M, Hezode C, Gerstoft J, Vierling JM, Mallolas J, Pol S, et al. Efficacy and safety of 8 weeks versus 12 weeks of treatment with grazoprevir (MK-5172) and elbasvir (MK-8742) with or without ribavirin in patients with hepatitis C virus genotype 1 mono-infection and HIV/hepatitis C virus co-infection (C-WORTHY): a randomised, open-label phase 2 trial. Lancet. 2015;385(9973):1087–97. CrossRefPubMed
Rockstroh JK, Nelson M, Katlama C, Lalezari J, Mallolas J, Bloch M, et al. Efficacy and safety of grazoprevir (MK-5172) and elbasvir (MK-8742) in patients with hepatitis C virus and HIV co-infection (C-EDGE CO-INFECTION): a non-randomised, open-label trial. Lancet HIV. 2015;2(8):e319–e27. CrossRefPubMed
European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2016. J Hepatol. 2017;66(1):153–94. CrossRef
Sozialversicherungsträger Hdö. Hochpreisige Medikamente und steigende Arbeitslosigkeit lassen Krankenkassen heuer in die roten Zahlen rutschen 2015. http://www.hauptverband.at/portal27/portal/hvbportal/content/contentWindow;jsessionid=34950CA18AD908A71B4F4B31ECD080A5.jbport_271_esvportal_a?contentid=10007.754367&action=2&viewmode=content. Accessed March 6th 2017.
Liverpool TUo. HEP Drug Interaction 2016. http://www.hep-druginteractions.org/. Accessed September 8th 2016
Lundgren J, Ryom L. et al. EACS Guidelines. Brussels: European AIDS Clinical Society (EACS); 2015.
San Lio MM, Carbini R, Germano P, Guidotti G, Mancinelli S, Magid NA, et al. Evaluating adherence to highly active antiretroviral therapy with use of pill counts and viral load measurement in the drug resources enhancement against AIDS and malnutrition program in Mozambique. Clin Infect Dis. 2008;46(10):1609–16. CrossRef
European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado.. EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237–64. CrossRef
Gounder PP, Haering C, Bruden DJ, Townshend-Bulson L, Simons BC, Spradling PR, et al. Does incorporating change in APRI or FIB-4 indices over time improve the accuracy of a single index for identifying liver fibrosis in persons with chronic hepatitis C virus infection? J Clin Gastroenterol. 2016; doi: 10.1097/MCG.0000000000000753.
Welzel TM, Petersen J, Herzer K, Ferenci P, Gschwantler M, Wedemeyer H, et al. Daclatasvir plus sofosbuvir, with or without ribavirin, achieved high sustained virological response rates in patients with HCV infection and advanced liver disease in a real-world cohort. Gut. 2016; doi: 10.1136/gutjnl-2016-312444.
Moser S, Schütz A, Marchart K, Ambrosch S, Karpi A, Gutic E, et al. Direct observed therapy of chronic hepatitis C with interferon-free all-oral regimens at a low-threshold drug treatment facility - a new concept for treatment of patients with borderline compliance receiving Opioid substitution therapy. J Hepatol. 2016;64(2):S822. CrossRef
- Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients
M.D. Philipp Schwabl
M.D. Theresa Bucsics
M.D. Bernhard Scheiner
M.D. Robert Strassl
M.D. Florian Mayer
M.D. Maximilian C. Aichelburg
M.D. Katharina Grabmeier-Pfistershammer
M.D. Michael Trauner
M.D. Markus Peck-Radosavljevic
M.D. Thomas Reiberger
M.D. Mattias Mandorfer
- Springer Vienna
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