Liver stiffness reduction and serum fibrosis score improvement in HIV HIV /hepatitis C virus‐coinfected patients treated with direct‐acting antivirals

摘要

Objectives Only a few studies have addressed liver stiffness dynamics after hepatitis C virus ( HCV ) treatment in patients with HIV / HCV coinfection. The aim was to evaluate the variation in liver stiffness and in serum liver fibrosis scores in HIV / HCV ‐coinfected patients before and after treatment with direct‐acting antivirals ( DAA s). Methods Liver stiffness measured using transient elastography as well as serum liver fibrosis scores [fibrosis‐4 ( FIB ‐4) score and the aspartate aminotransferase to platelet ratio index ( APRI )] were evaluated before and at 6–12?months after DAA treatment. Variation in the outcome variables was evaluated using the Wilcoxon nonparametric test. Univariate analysis and multivariate regression models were used. Results A total of 78 HIV / HCV ‐coinfected subjects were included in the study. Median values of hepatic stiffness significantly decreased after DAA treatment compared with baseline [16.8 (interquartile range ( IQR ) 10.2–27.0) kP a at baseline vs . 9.4 ( IQR 6.7–15.0) kP a after DAA treatment; P? ? 0.01). Further, a decrease in median FIB ‐4 score [2.8 ( IQR 1.5–4.8) vs . 2.0 ( IQR 1.3–3.2), respectively; P? ? 0.01] and APRI [0.9 ( IQR 0.5–2.2) vs . 0.4 ( IQR 0.2–0.7), respectively; P? ? 0.01] was found. In univariate analysis, liver stiffness decrease was associated with increasing age, ‘other’ HCV genotype ( vs . G1), the presence of cirrhosis, higher pre‐ DAA liver stiffness, sofosbuvir‐based regimens and longer DAA treatment (all P? ? 0.05). Multivariate regression confirmed the significance of the association only with higher baseline liver stiffness ( P? ? 0.01). Greater FIB ‐4 and APRI reductions were associated with higher respective baseline values, while the presence of hepatic steatosis correlated with lower score reduction after DAA. Conclusions A reduction in liver stiffness and an improvement in fibrosis scores were observed in HIV / HCV ‐coinfected patients soon after DAA treatment. The clinical implications of these observations need to be evaluated in larger populations with longer follow‐up.