Liver fibrosis progression and clinical outcomes are intertwined: role of CD4+ T-cell count and NRTI exposure from a large cohort of HIV/HCV co-infected patients with detectable HCV RNA. A MASTER Cohort study

Emanuele Focà

Introduction: Patients HIV/HCV suffer from faster clinical and liver fibrosis (LF) progression. We evaluated predictors and incidence of these events in a multi-centre cohort.
Methods: We selected all HIV+ patients starting a first-line cART, with detectable HCV RNA, without exposure to IFN/RBV, with ≥2 FIB-4 index before cART. K-M analysis was used to estimate incidence of clinical outcomes and LF progression. Cox regression was used to assess the possible predictors.
Results: 1,433 patients were selected: 745 clinical events occurred, with an incidence of 7.6% over 9,811 PYFU and a median survival time of 9.3 years. Incidence of LF progression from FIB-4 class 1 was 12.4%, and from FIB-4 class 2 was 7% with a median survival time of 5.6 and 10.3 years, respectively. At multivariate analyses, IDU and time-updated γGT were negative predictors of clinical and LF progression. Higher CD4+ protected from clinical events, and lower HIV-RNA and higher CD4+ appeared to protect from LF progression. Current FIB-4 class 3 predicted clinical events, while prolonged exposure to NRTIs was a negative predictor for any outcomes.
Conclusion: Both clinical and LF progression in HIV/HCV co-infected patients depend on immune status. IDU and patients with high γGT (a proxy for alcohol abuse) are most-at-risk. Therefore, these patients should be prioritized for the access to anti-HCV therapy. Possible benefits of NRTI sparing regimens in HIV/HCV co-infected patients should be investigated

Simone Agnello
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