Does fibrosis really regress in HIV/hepatitis C virus co-infected patients after treatment with direct antiviral agents?

Autor:	Rial-Crestelo D; Hospital Universitario 12 de Octubre, Madrid.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Sepúlveda MA; Hospital Virgen de la Salud, Toledo.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., González-Gasca FJ; Hospital General, Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Geijo-Martínez P; Hospital General Virgen de la Luz. Cuenca.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Martínez-Alfaro E; Hospital General Universitario de Albacete, Albacete.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Barberá JR; Hospital General la Mancha Centro, Alcázar de San Juan, Ciudad Real.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Yzusqui M; Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Casallo S; Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., García M; Hospital General de Villarrobledo, Villarrobledo, Albacete.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Hornero CM; Hospital de Santa Bárbara, Puertollano, Ciudad Real.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Espinosa-Gimeno A; Hospital Universitario, Guadalajara.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain., Torralba M; Hospital Universitario, Guadalajara.; Grupo de Estudio de Castilla la Mancha de Enfermedades Infecciosas (GECMEI), Spain.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2020 Mar 01; Vol. 34 (3), pp. 427-432.
DOI:	10.1097/QAD.0000000000002433
Abstrakt:	Objective: To evaluate the progression of liver stiffness after treatment with direct antiviral agents (DAAs), to identify predictive factors of fibrosis regression and to analyze the changes of scores AST-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) after treatment. Design: Multicenter prospective cohort study of HIV/HCV co-infected patients conducted within the GECMEI cohort, Spain. Methods: Individuals were eligible if they were willing to start DAAs and underwent two transient elastographies: at baseline and after the end of treatment (EOT). All patients with detectable HCV RNA naïve to DAAs were consecutively enrolled from nine medical hospitals. Liver stiffness results were categorized in four Metavir stages (F1: <7.1; F2 : 7.1--9.5; F3 : 9.5--2.4; F4: >12.4 kPa). The APRI and FIB-4 scores were calculated at baseline, EOT and 12 weeks after EOT. Results: One hundred and seventy-eight patients were examined throughout a follow-up of 16.3 months (IQR: 12.5-25). The median of liver stiffness decrease was 2.6 kPa (IQR: 0-6.3). A greater improvement was observed in F3-F4 compared with F1-F2, (6.4 vs. 0.91 kPa, P < 0.001; P = 0.001, respectively). A decline between baseline and EOT measures was observed in APRI and FIB-4 (P < 0.001). Sustained virological response (SVR12) achievement was the only predictor of fibrosis regression [OR:17.4 (95% CI: 1.8-164.6; P = 0.013)]. Conclusion: Most patients experienced a significant reduction of liver stiffness and APRI and FIB-4 scores. This improvement was greater in those with advanced liver disease. SVR12 was the only predictor of fibrosis regression. The significance of this reduction is unclear and could reflect a decline in inflammation rather than true fibrosis regression.
Databáze:	MEDLINE
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