Clinical effects of viral relapse after interferon plus ribavirin in patients co-infected with human immunodeficiency virus and hepatitis C virus

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• 作者：Juan Berenguer¹ ; ² ; ^&dagger ; ; ^jbb4@me.com ; Julio Alvarez-Pellicer³ ; Ana Carrero¹ ; ² ; Miguel A. Von Wichmann⁴ ; José ; Ló ; pez-Aldeguer⁵ ; Josep Mallolas⁶ ; Marí ; a J. Galindo⁷ ; Eva Van Den Eynde⁸ ; Marí ; a J. Té ; llez⁹ ; Carmen Quereda¹⁰ ; Cristina Tural¹¹ ; José ; Sanz¹² ; Carlos Barros¹³ ; Ignacio Santos¹⁴ ; Federico Pulido¹⁵ ; Josep M. Guardiola¹⁶ ; Enrique Ortega¹⁷ ; Rafael Rubio¹⁸ ; Juan J. Jusdado¹⁹ ; Marí ; a L. Montes¹⁹ ; ³ ; Gabriel Gaspar²⁰ ; Elena Barquilla²¹ ; José ; M. Belló ; n¹ ; ² ; Juan Gonzá ; lez-Garcí ; a³ ; ^&dagger ; ; The GESIDA HIV/HCV Cohort Study Group
• 关键词：HIV ; human immunodeficiency virus ; HCV ; hepatitis C virus ; cART ; combination antiretroviral therapy ; GESIDA ; Grupo de Estudio del SIDA de la Sociedad Españ ; ola de Enfermedades Infecciosas y Microbiologí ; a Clí ; nica (AIDS Study Group of th
• 刊名：Journal of Hepatology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：58
• 期：6
• 页码：1104-1112
• 全文大小：873 K

文摘

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Background & Aims

Sustained viral response (SVR) after therapy with interferon-ribavirin (IF-RB) reduces liver-related (LR) complications and mortality in HIV/HCV-co-infected patients. Here, we assess the impact of end-of-treatment response with subsequent relapse (REL) on LR events (LR death, liver decompensation, hepatocellular carcinoma, or liver transplantation), and liver stiffness (LS) by transient elastography.

Methods

We analyzed the GESIDA 3603 Cohort (HIV/HCV-co-infected patients treated with IF-RB in 19 centers in Spain). Response to IF-RB was categorized as SVR, REL, and no response (NR). The study started when IF-RB was stopped and ended at death or the last follow-up visit. Multivariate regression analyses were adjusted for age, sex, HIV category of transmission, CDC clinical category, nadir CD4+ cell count, HCV genotype, HCV-RNA viral load, and liver fibrosis.

Results

Of 1599 patients included, response was categorized as NR in 765, REL in 250 and SVR in 584. Median follow-up was more than 4 years in each group. Taking the group of patients with NR as reference, we found that the adjusted hazard ratios (95 % confidence interval) of liver-related events (liver-related death, liver decompensation, hepatocellular carcinoma, liver transplantation) for patients with REL and for patients with SVR were 0.17 (0.05; 0.50) and 0.03 (0; 0.20), respectively. We also found that SVR was followed by less liver stiffness than both REL and NR. However, REL was associated with less liver stiffness than NR.

Conclusions

Best outcomes were achieved with an SVR. However, REL was associated with less LR mortality, decompensation, and liver stiffness than NR.