HIV/HCV co‐infected cirrhotic patients are no longer at higher risk for HCC or end‐stage liver disease as compared to HCV mono‐infected patients

Abstract

Introduction

It is widely accepted that HIV infection is a risk factor for increased severity of HCV liver disease. However, owing to better efficacy and safety of cART, and increased access to HCV therapy, whether this condition remains true is still unknown.

Methods

1,253 HCV mono‐infected patients and 175 HIV/HCV co‐infected cirrhotic patients, included in two prospective French national cohorts (ANRS CO12 CirVir and CO13 HEPAVIH) were studied. Cirrhosis was compensated (Child‐Pugh A), without prior history of complication, and assessed on liver biopsy. Incidences of liver decompensation, hepatocellular carcinoma (HCC) and death according to HIV status were calculated by a Fine‐Gray model adjusted for age. Propensity score matching was also performed to minimize confounding by baseline characteristics.

Results

At baseline, HIV/HCV patients were younger (47.5 vs. 56.0 years, p<0.001), more frequently males (77.1% vs. 62.3%, p<0.001), and had at baseline and at end of follow‐up, similar rates of HCV eradication than HCV mono‐infected patients. 80.4% of HIV/HCV patients had an undetectable HIV viral load. After adjustment for age, 5‐year cumulative incidences of HCC and decompensation were similar in HIV/HCV and HCV patients (8.5% vs. 13.2%, p=0.12 and 12.8% vs. 15.6%, p=0.40, respectively). Overall mortality adjusted for age was higher in HIV/HCV co‐infected patients (SHR=1.88; 95% CI: 1.15‐3.06, p = 0.011). Factors associated with liver decompensation and HCC were age, absence of SVR and severity of cirrhosis, but not HIV status. Using a propensity score matching 95 patients of each group according to baseline features, similar results were observed.

Conclusion

In HCV‐infected cirrhotic patients, HIV co‐infection was no longer associated with higher risks of HCC and hepatic decompensation. Increased mortality however persisted, due to extra‐hepatic conditions.

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