16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

THREE YEARS ASSESSMENT OF THE RISK OF END-STAGE LIVER DISEASE IN HIV/HCV CO-INFECTED PATIENTS TREATED FOR A CHRONIC HCV INFECTION

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAb0301

F. Carrat¹, P. Cacoub², S. Pol³, C. Goujard⁴, L. Piroth⁵, P. Morand⁶, D. Salmon-Céron⁷, G. Pialoux⁸, C. Azzag-Benredjem9, P. Bedossa¹⁰, C. Perronne¹¹, F. Bani-Sadr⁹, the ANRS CO7 cohort study team
¹ GHU-Est, INSERM, UMR S 707, Paris, France, ² GHU-Est, Internal medicine, Paris, France, ³ GHU-Ouest, INSERM, Hepatology, Paris, France, ⁴ GHU-Sud, Infectious diseases, Paris, France, ⁵ CHU, Infectious diseases, Dijon, France, ⁶ CHU, Virology, Grenoble, France, ⁷ GHU-Ouest, Infectious diseases, Paris, France, ⁸ GHU-Est, Infectious diseases, Paris, France, ⁹ INSERM, UMR S 707, Paris, France, ¹⁰ GHU-Nord, Pathology, Paris, France, ¹¹ CHU, Infectious diseases, Garches, France

BACKGROUND: The clinical implications of a sustained virologic response in HIV-infected patients who received a treatment for a chronic Hepatitis C Virus (HCV) infection are unknown.

METHODS: We prospectively followed 247 patients who were enrolled in a randomized controlled trial of interferon-ribavirin combination. The follow-up in the cohort started six-months after the last follow-up visit in the trial. The median follow-up in the cohort was 30 months. We studied the risk of end-stage liver disease (ELD) event defined as a liver decompensation leading to hospitalization, liver transplantation, hepatocellular carcinoma, or death.

RESULTS: At randomization, patients (40y, 74% male, 77% IVDU) belonged to the CDC class A, B & C in 51, 34 & 14%, respectively, and were given HAART in 83% with a mean CD4 cell count of 532/microliter, HIV RNA < 200 cp/ml in 66%. The mean Metavir score was A 1.3, F 2.2; 36% had F3 – F4. 71 patients (29%) had a sustained virologic response (negative PCR 6 months after therapy), 127 (51%) were HCV genotype 1 or 4 and 49 (20%) HCV genotype 2 or 3 infected non responders. Nine patients (4%) experienced ELD events during the follow-up (6 died). At three years, the survival-free of ELD event was 93% in non responders vs 100% in responders (P=0.051 Log-Rank test); 88% in patients with F3 – F4 score vs 98% in F1 – F2 (p=0.007). No event occurred in 25 patients with F3 – F4 score who cleared HCV (figure). No other factor (HCV or HIV) was found related to the survival.

CONCLUSIONS: Extensive fibrosis or cirrhosis are associated with ELD events which disappear in HIV/HCV co-infected treated patients with sustained virological response.

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2006-08-13
TuAb0301

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