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DAA therapy cures most people with HIV/HCV co-infection with decompensated cirrhosis or liver transplants
Liz Highleyman, 2017-03-08 07:40:00
People with HIV/hepatitis C virus (HCV) co-infection with
liver cirrhosis or liver failure, and those who received liver transplants, saw
high rates of sustained virological response using interferon-free
direct-acting antiviral (DAA) therapy for hepatitis C, according to three
Spanish studies presented at the Conference on Retroviruses and Opportunistic
Infections (CROI 2017) last month in Seattle.
As expected, cure rates were not as high as those seen
in people with less advanced liver disease. However, they were similar to those
of HIV-negative people with HCV mono-infection at similar stages of liver
Over years or decades
chronic HCV infection can lead to serious complications including cirrhosis,
liver failure and the need for a liver transplant. Liver function typically
diminishes gradually, as the liver can compensate for some damage. But
eventually scar tissue blocks normal blood flow and the liver cannot carry out
its vital functions –
a condition known as decompensated cirrhosis.
People with decompensated
liver disease may develop symptoms such as ascites (abdominal fluid build-up),
bleeding veins in the oesophagus and stomach and hepatic encephalopathy (brain
impairment). People with HIV/HCV co-infection appear to progress to
decompensation more frequently and more rapidly
than those with HCV alone.
Decompensated patients are classified as Child-Pugh class
B or C, based on a set of liver function biomarkers and symptoms. The MELD scoring system (based
on bilirubin, creatinine and blood clotting capacity) is used to
prioritise candidates for liver transplants.
During the interferon era many people
with decompensated cirrhosis and liver transplant recipients could not tolerate
hepatitis C treatment, and pegylated interferon plus ribavirin was not very
effective for these groups. Many experts once considered decompensation a
contraindication for treatment, but the advent of DAAs has changed this.