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25.07.2017 | original article | Ausgabe 3-4/2018 Open Access

Wiener klinische Wochenschrift 3-4/2018

Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 3-4/2018
Autoren:
David Chromy, M.D. Philipp Schwabl, M.D. Theresa Bucsics, M.D. Bernhard Scheiner, M.D. Robert Strassl, M.D. Florian Mayer, M.D. Maximilian C. Aichelburg, M.D. Katharina Grabmeier-Pfistershammer, M.D. Michael Trauner, M.D. Markus Peck-Radosavljevic, M.D. Thomas Reiberger, M.D. Mattias Mandorfer
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi: 10.​1007/​s00508-017-1231-x) contains supplementary material, which is available to authorized users.

Summary

Background and aim

Hepatitis C virus (HCV) therapy should be considered without delay in all patients with significant (SIGFIB) or advanced liver fibrosis (ADVFIB). We aimed to investigate the rates of treatment initiation with interferon-free regimens within a screening program for SIGFIB/ADVFIB in human immunodeficiency virus/HCV coinfected patients (HIV/HCV).

Methods

The FIB-4 was calculated in all HIV/HCV from 2014–2016. HIV/HCV were counselled by the HIV clinic and referred to the Division of Gastroenterology and Hepatology for transient elastography (TE) and evaluation for HCV therapy. Patients were stratified by FIB-4 of </≥1.45 (established cut-off for ruling out ADVFIB) and SIGFIB/ADVFIB were defined by liver stiffness >7.1 kPa/>9.5 kPa, respectively.

Results

Among 1348 HIV+ patients, 16% (210/1348) had detectable HCV-RNA. One hundred HIV/HCV had a FIB-4 ≥1.45. Among these, 57% (57/100) underwent TE. The majority of these patients had SIGFIB (75%; 43/57) or ADVFIB (37%; 21/57), however, interferon-free treatment was initiated in only 56% (24/43).
In addition, fifty-two percent (57/110) of HIV/HCV with FIB-4 <1.45 underwent TE. Interestingly, 40% (23/57) and 18% (10/57) of these patients showed SIGFIB or even ADVFIB, respectively, and 78% (18/23) finally received interferon-free treatment. Overall, only 20% (42/210) of HIV/HCV received interferon-free treatment.

Conclusion

FIB-4 was not useful for ruling out SIGFIB/ADVFIB in our cohort of HIV/HCV. Treatment was initiated only in a small proportion (20%) of HIV/HCV during the first 2 years of interferon-free treatment availability, although the observed proportion of patients with SIGFIB (assessed by TE) was considerably higher (58%). Thus, it requires the ongoing combined efforts of both HIV and HCV specialists to increase treatment uptake rates in this special population.
Zusatzmaterial
Supplementary Table 1 Comparison of all HIV/HCV coinfected patients with FIB-4 <1.45 and ≥1.45
508_2017_1231_MOESM1_ESM.docx
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