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Transcript of Management of HIV / HCV Coinfection - Albany Medical … · 2015-07-23 · Management of HIV / HCV...
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Advances in HCV 2015Albany Medical College & Erie County Medical Center
Buffalo, New York
24 June 2015
Management of HIV / HCV Coinfection
Norbert Bräu, MD, MBA
Prof. of Medicine, Icahn School of Medicine at Mount Sinai, New York NYDivisions of Infectious Diseases & Liver Diseases
Director, Viral Hepatitis Program, James J Peters VA Medical Center, Bronx NY
Bronx VA Medical Center Mount Sinai School of Medicine
HIV / HCV coinfectionOverview
(1)Natural History of HCV Disease in HIV / HCV
(2) HCC in HIV
(3) Antiviral Therapy with DAAs for HIV / HCV
3
HIV History
5 June 1981 MMWR: Los Angeles, Pneumocystis carinii pneumonia in 5 homosexual men.
1983 HTLV-III discovered (renamed HIV)1989 Zidovudine (AZT) first antiretroviral drug1996 HIV protease inihibitors, beginning of HAART
Since 2000 liver disease increasing cause of mortality in HIV0-uinfected patients
Effect of HAART on Survival
4
Rising rate of liver-related deathsand of HCC
France: Mortalité 2000 & 2005
2000 2005N ~64,000 78,000
Deaths 964 1,042
Liver deaths: 13.4% 15.4%
HCC deaths: 15% 25% p=0.03
Salmon-Ceron D, J Hepatol, April 2009
HIV and HCV CoinfectionEpidemiology
HCV or HBV within HIV+ pts:
HCV strongly depends on mode of transmission of HIV itself:
Anti-HCV[+], total 42.5% HBsAg[+], total 6.9%IDU 91 %
blood transfusion 71 %
sexual transmission 7.1 %
N=1,935
Saillour F et al., Brit Med J, 1996
5
Natural History of HCV Infection
Acute Infection
Resolved Chronic
CirrhosisStable
SlowlyProgressive
Liver failure, HCCTransplant
Death
20% (15)
25% (25) 75% (75)
25% (4)
80% (60)
75% (11)
HIV and Alcohol
100% (100)
HIV + HCV coinfectionEffect of HIV on HCV-related liver disease
Does HIV accelerate
HCV-induced liver disease ?
YES, if …
6
HIV + HCV coinfection:Liver Fibrosis Progression Rate
Benhamou Y, Hepatology, Oct 1999
HIV positive (n=122)Matched controls (n=122)Simulated controls (n=122)
HCV - infection duration (years)
Fibr
osis
Gra
des
(MET
AVR
scor
ing
syst
em) 4
3
2
1
00 10 20 30 40
Fibrosis Progression Rate by HIV Viral Load
Bräu N, J Hepatol, Jan 2006
7
Fibrosis progression in HIV/HCV coinfeciton- paired liver biopsies -
Spain, multicenter: N=135 HIV/HCV with paired Bx (median 3.3 yrs)
Factors independently correlated with Fibrosis Progression Rate (FPR)
risk ratio 95% CI p
HIV RNA undetectable (>70% dur F/U) 0.61 0.39 – 0.93 0.028
HAART during F/U 0.94 0.72
Baseline necroinflammation 1.77 1.16 – 2.7 0.009
EOT response to anti-HCV therapy 0.41 0.19 – 0.88 0.023
Macias J, Hepatology, Oct 2009
50
Fattovich G et al. Gastroenterology. 1997;112:463.
40
30
20
10
0 2 4 6 8 10
100
80
60
40
20
0 2 4 6 8 10
Years Years
HCV Cirrhosis -- Natural HistoryMorbidity and Mortality
HCC Cirrhosis Decompensation
Cumulative decomp. and HCC(%) Cumulative mortality(%)
8
Effect of HIV on HCV-related cirrhosis
Cumulative incidence of liver failure in HIV/HCV pts. with cirrhosis (N=154)
6.40 cases / 100 person-yrs
Est. 3-yr incid. 48 %
Est. 5-yr incid. 53 %
Pineda JA, Clin Infect Dis, 15 Oct 2009
Effect of HIV on HCV-related end-stage liver disease
Shorter survival after decompensation in HIV/HCV vs. HCV (N=1,837)
median HIV/HCV 16 mo
HCV 48 mo
Independent risk factors for death:HIV+, age, MELD score, HE 1st Sx
Pineda JA, Hepatology, Apr 2005
9
HCC in HIV – Rising IncidenceAndalucia (Spain) 1999 – 2010
n = 14,300 (2010)
Merchante N. et al., Clin Infect Dis, Jan 2013
HIV / HCV
All HIV patients 0.1 0.2 0.5 0.7 1.0 0.9
HCC in HIV – Rising Prevalence
VA System (USA) 1996 – 2009
n = 24,000 (2009)
Ioannou GN. et al., Hepatology, Jan 2013
10
HCC in HIV - Outcome
Case Series
2001 n= 7 García-Samaniego J et al. (Madrid), Am J Gastro
HCC in HIV - Outcome
Case Series
2001 n= 7 García-Samaniego J et al. (Madrid), Am J Gastro
2004 n=41 Puoti M et al. (Italy), AIDS
2007 n=63 North American Liver Cancer in HIV Study GroupBräu N et al., J Hepatol
2011 n=102 Berretta M et al. (Italy), Oncologist
11
HCC in HIV - Outcome
Case Series
2001 n= 7 García-Samaniego J et al. (Madrid), Am J Gastro
2004 n=41 Puoti M et al. (Italy), AIDS
2007 n=63 North American Liver Cancer in HIV Study GroupBräu N et al., J Hepatol
2011 n=102 Berretta M et al. (Italy), Oncologist
2012 n=26 Yopp AC et al. (Dallas), Clin Gastroent Hepatol2012 n=23 Lim C at al. (Paris), JAIDS2013 n=48 Pavoni M et al. (Bologna, Italy), Dig Liver Dis
Puoti M et al., AIDS, Nov-2004
1st Italian HCC in HIV study (2004)
Median survival:
HIV-pos. (n=41) 5.9 mo
HIV-neg. (n=701) 18.0 mo
HCC in HIV - Outcome
12
****
*
*
**
*
*
*
12 sites (US, Canada) HIV-pos. HCC (n=63)
4 sites HIV-pos. + HIV–neg. HCC (n=226)
North American Liver Cancer in HIV Study Group
* *
*
*
*
*
*
Bräu N et al., J Hepatol, Oct 2007
At risk HIV[-] 226 64 29 14 7 2 1 median survival: 7.5 moAt risk HIV[+] 63 11 3 1 1 0 0 median survival: 6.9 mo
N American HCC in HIV Study: Survival All Patients
Bräu N et al., J Hepatol, Oct 2007
13
Berretta M et al., Oncologist, 2011
2nd Italian HCC in HIV study (2011)
Median survival:
HIV-pos. 35 mo
HIV-neg. 59 mo
Comparison Survival HIV(+) vs. HIV(-)
NMedian survival (mo)
Study HIV(+) HIV(‐) HIV(+) HIV(‐) pItaly (2004) 41 701 5.9 18.0 0.045North America (2007) 63 226 6.9 7.5 0.44Italy (2011) 104 484 35 59 0.048
Dallas (2012) 26 164 9.6 5.2 0.85Paris (2012) 23 46 18 26 0.2Bologna (2013) 48 234 16 30 0.035
14
••
•••
• ••••
••
• ••••••• •
•••
• NAn=281
SAn=24
EURn=59
Liver Cancer in HIV Study GroupN=365 as of 05-May-2014
•AUSn=1
•
Does Screening for HCC in HIV/HCV Patients Improve Survival ?
Method:N=198 HIV/HCV patients with HCC
Diagnosis of HCC via Screening vs. Symptoms
Compare:* Staging* Therapy* Survival (adjust for lead-time bias)
15
Screening for HCC in HIV/HCV Patients
Patient Characteristics
Screenedn=117(59%)
Not Screenedn=81(41%)
P
Age (yrs), Mean 52 54 0.082
Female Sex 4% 10% 0.162
Alcohol abuse 30% 50% 0.003
CTP Score: 6.6 7.7 <0.001
HIV parameters Median CD4+ cells (per mm3)
HIV RNA <400 copies/mL
344
79%
274
54%
0.027
<0.001
Fox RK, AASLD, Washington DC, Nov 2013
Screening for HCC in HIV/HCV Patients
Screenedn=117
Not Screened
n=81P
Hepatic LesionsMultiple Tumors 42% 58% 0.035
Median Size Largest Tumor (cm)
3.0 5.2 <0.001
Portal Vein ThrombosisExtrahepatic Metastases
12%9%
31%28%
0.001<0.001
Meets Milan criteria for OLT
64% 29% <0.001
Tumor Characteristics
Screenedn=117
Not Screened
n=81
P
BCLC Stage, n (%)ABC } Advanced,D } Incurable
BCLC Stages C and D
44%17%27%11%
39%
7%20%43%30%
73%
<0.001
<0.001
HCC Tumor Staging
Fox RK, AASLD, Washington DC, Nov 2013
16
Screenedn=117
Unscreenedn=81
P
Potentially Curative, n (%)Radiofrequency AblationPercutaneous Ethanol InjectionSurgical ResectionLiver Transplantation
Effective, Non-Curative, n (%)ChemoembolizationSorafenibSorafenib & Chemoembolization
No Therapy, n (%)
53 (46%)198
179
35 (30%)2843
28 (24%)
10 (12%)5221
17 (21%)1430
54 (67%)
<0.001
Any HCC Therapy 88 (76%) 27 (33%)
Screening for HCC in HIV/HCV Patients
HCC Therapy
Fox RK, AASLD, Washington DC, Nov 2013
Screening for HCC in HIV/HCV Patients Survival – adjusted for lead-time bias (8.6 mo)
Median survivalScreened 19.2 moUnscreened 3.5 mo
Fox RK, AASLD, Washington DC, Nov 2013
17
Screening for HCC in HIV/HCV Patients Cox Proportional Hazard Analysis
Fox RK, AASLD, Washington DC, Nov 2013
Risk FactorUnivariate
Hazard Ratiofor Death
Univar.P
Multi-Variable
H.R.for death
95% confid. Interval
Multi-var.P
Effective HCC Therapy 0.13 <0.001 0.21 0.13 – 0.35 <0.001
HCC Screening 0.22 <0.001 0.38 0.24 – 0.58 <0.001
BCLC stages A&B vs. C&D 0.36 <0.001 0.58 0.38 – 0.89 0.012
AFP (per 1000 ng/ml) 1.004 0.061
Alcohol abuse 1.84 0.001
CD4+ cells (per 100/mm3) 0.89 0.014
HIV RNA (per log10 copies/ml) 1.31 <0.001
Screening for HCC in HIV/HCV Patients Screening over Time
52% 49%
77%
0%
20%
40%
60%
80%
100%
1995 - 2004 2005 - 2008 2009 - 2013
p=0.002
Fox RK, AASLD, Washington DC, Nov 2013
18
HIV Viral Load & Natural History of HCC
Hypothesis: HIV viremia negatively influences course of HCC
In HIV/HCV: More rapid progression of hepatic fibrosiswith HIV RNA 400+ Copies/ml
Fibrosis Progression Rate by HIV Viral Loadin chronic hepatitis C
Bräu N, J Hepatol, Jan 2006
19
HIV Viremia: Influence on HCC Survival
HIV RNA <400 c/ml
n=254
HIV RNA400+ c/ml
n=93P
Age (yrs), Mean 53.8 52.0 0.078
Male Sex 234 (92%) 85 (91%) 0.83
Etiology of HCCHepatitic CHepatitis BNon-Viral (NASH, Alcohol)
201 (79%)49 (19%)4 (2%)
71 (76%)21 (23%)1 (1%)
0.78
Alcohol Abuse 57 (23%) 36 (41%) 0.001
Platelet count (1000/mm), Mean 146 163 0.16
Child-Pugh Score, Mean 6.6 7.5 <0.001
HCC Diagnosis via Screening 174 (69%) 41 (44%) <0.001
CD4+ Cells (per mm3), Median 347 244 <0.001
Citti, AASLD 2014, Boston MA
HIV Viremia: Influence on HCC Survival
Citti, AASLD 2014, Boston MA
Median survival
HIV RNA <400 c/ml 19.8 monthsHIV RNA 400+ c/ml 5.4 months
At Risk
HIV RNA <400 254 107 60 35 23 10 4 3 2 1 1
HIV RNA 400+ 93 22 13 7 7 4 4 4 3 1 0
Survival at 1 yr 2 yrs
HIV RNA <400 c/ml 61% 46%HIV RNA 400+ c/ml 36% 27%
20
HIV Viremia: Influence on HCC Survival
Factor Univar.
H.R. for
Death
Univar.
P
Multi‐variable
H.R. for Death
95% Conf.
Interval
Multi‐var.
P
HCC Diagnosis through Screening 0.23 <0.001 0.35 0.25 – 0.49 <0.001
BCLC stages A&B vs. C&D 0.38 <0.001 0.58 0.41 – 0.83 0.003
Alcohol abuse 1.97 <0.001 1.64 1.18 – 2.28 0.003
Extrahepatic Metastases 2.59 <0.001 1.65 1.13 – 2.41 0.009
Portal Vein Thrombosis 1.51 <0.001 1.56 1.08 – 2.24 0.016
Child‐Pugh score (per unit) 1.26 <0.001 1.15 1.06 – 1.25 0.001
HIV RNA Level (per log10 cop./ml) 1.33 <0.001 1.16 1.03 – 1.30 0.013
CD4+ cell Count (per 100/mm3) 0.89 0.001
Platelet Count (per 100,000/mm3) 1.12 0.006
Solitary Liver Tumor 0.67 0.008
Multi-Variable Cox Regression Analysis
Citti, AASLD 2014, Boston MA
Total Cohort N=367 (100%)
Comparison of OLT with other curative therapies:
OLT n= 27 (7.4%)
Other Curative Therapy n=108 (29.5%)
Surgical Resection 51
Radiofrequency Ablation 45
Percutaneous Ethanol Inject. 12
Liver Transplantation for HCC in HIV
Platt H, AASLD 2014, Boston MA
21
Liver Transplantation for HCC in HIV
OLTn=29
Other Curative Rx
n=108P
Age (yrs), Mean 50.0 53.4 0.060
Etiology of HCCChronic Hepatitis CChronic Hepatitis BNon-Viral (Alcohol, NASH)
21 (78%)6 (22%)
0
84 (78%)22 (20%)2 (2%)
0.77
Excessive Alcohol 6 (22%) 26 (26%) 0.73
Child-Pugh score, Mean 6.8 5.8 0.026
HIV RNA <400 copies/mL 18 (82%) 85 (83%) 0.94
CD4+ Cells (per mm3), Median 322 423 0.36
OLTn=27
Other Curative Rx
n=108P
Hepatic Lesions Mulitple Tumors
Size Largest Lesion (cm), Median (Range)
15 (56%)
3.0 (1.3 – 5.6)
22 (20%)
2.85 (0.5 – 11)
<0.001
0.98
AFP level (ng/ml), Median
13.0 44.5 0.022
Extrahepatic metastases 0 7 (6.5%) 0.17
Meets Milan Criteria for OLT
21 (78%) 83 (80%) 0.82
Platt H, AASLD 2014, Boston MA
Liver Transplantation for HCC in HIV
Platt H, AASLD 2014, Boston MA
Survival at: 2 yrs 5 yrs
OLT 92% 85%Other Cur. Rx 71% 52%
22
Liver Transplantation for HCC in HIV
Platt H, AASLD 2014, Boston MA
Survival at: 2 yrs 5 yrs
OLT 92% 85%Other Cur. Rx 71% 52%
Survival at: 2 yrs 5 yrs
OLT 92% 85%Radiofrequ. Abl. 71% 68%Surg. Resection 77% --Ethanol Inject. 41% --
Vibert E et al., Hepatology, Feb 2011
Other Reports of Transplantation for HCC in HIV
Single center, Paris HIV(+) 21 16 OLT HIV(-) 65 58 OLT(76%) (89%)
Survival
23
HCV Antiviral Therapy in HIV/HCV Coinfection
• Ledipasvir (NS5a) + sofosbuvir (NA) (Harvoni®)
• ERADICATE (N=50) GT 1 nv F0-F3
• ION-4 (N=355) GT 1 nv/exp 20% cirrh
•AbbVie 3D + RBV (Viekira Pak®)
• TURQUOISE-I (part A N=63) GT 1 nv/exp +/- cirrh
• Daclatasvir (NS5a) + sofosbuvir
• ALLY-3 (N=203) GT 1-6 nv 13% cirrh
• Grazoprevir (PI) + elbasvir (NNI)
• C-EDGE-Coinfection GT-1 -4 -6
LDV + SOF in GT1 Treatment‐Naïve HCV/HIV Coinfection: ERADICATE: Efficacy
ARV Untreated: LDV/SOF (n = 13)
ARV Treated: LDV/SOF (n = 37)
N = 50 GT1, TN Stable HIV
Study Weeks
SVR 12
12 24
Osinusi A, et al. JAMA. 2015 Feb 23. [Epub ahead of print].
SVR 12
100% 100% 100% 100% 100% 100%100% 100% 100%97% 97% 97%
0%
20%
40%
60%
80%
100%
Week 4 Week 8 EOT SVR4 SVR8 SVR12
% Patients with HCV RNA < LLO
Q
ARV Untreated (n = 13) ARV Treated (n = 37)
24
LDV/SOF for 12 Weeks in HIV/HCV Coinfection ION‐4: Study Design
N=335 LDV/SOF
Wk 0 Wk 12
Wk 24
Phase 3, multicenter (US, Canada, New Zealand)
HCV GT 1 + 4, nv/exp, 20% cirrhosis
HIV‐1 positive, HIV RNA <50 copies/mL; CD4 cell count >100 cells/mm3
ART regimens included FTC and TDF plus EFV, RAL, or RPV, no PIs
Naggie S, et al. NEJM 2015 [in press]
SVR12
LDV/SOF 12 Weeks
Overall Naïve vs Experienced Cirrhosis Status
96 95 97 96 94
0
20
40
60
80
100
SV
R12
(%
)
321/335 179/185 258/268 63/67142/150
CirrhosisNo CirrhosisExperiencedNaïve
LDV/SOF for 12 Weeks in HIV/HCV Coinfection ION‐4: Efficacy
Naggie S, et al. NEJM 2015 [in press]
25
LDV/SOF 12 Weeks
Overall Naïve vs Experienced Cirrhosis Status
96 95 97 96 94
0
20
40
60
80
100
SV
R12
(%
)
321/335 179/185 258/268 63/67142/150
CirrhosisNo CirrhosisExperiencedNaïve
LDV/SOF for 12 Weeks in HIV/HCV Coinfection ION‐4: Efficacy
Naggie S, et al. NEJM 2015 [in press]
Stable CD4 counts through treatment and follow‐up phase
No patient had confirmed HIV virologic rebound
Overall safety
Patients, n (%)
LDV/SOF 12 WeeksN=335
AEs 257 (77)
Grade 3‒4 AE 14 (4)
Serious AE 8 (2)*
Treatment D/C due to AE 0
Death 1 (<1)†
Grade 3‒4 laboratory abnormality
36 (11)
LDV/SOF for 12 Weeks in HIV/HCV Coinfection ION‐4: Safety
Naggie S, et al. CROI 2015.
26
Stable CD4 counts through treatment and follow‐up phase
No patient had confirmed HIV virologic rebound
Overall safety
Patients, n (%)
LDV/SOF 12 WeeksN=335
AEs 257 (77)
Grade 3‒4 AE 14 (4)
Serious AE 8 (2)*
Treatment D/C due to AE 0
Death 1 (<1)†
Grade 3‒4 laboratory abnormality
36 (11)
LDV/SOF for 12 Weeks in HIV/HCV Coinfection ION‐4: Safety
Naggie S, et al. CROI 2015.
Stable CD4 counts through treatment and follow‐up phase
No patient had confirmed HIV virologic rebound
Overall safety
Patients, n (%)
LDV/SOF 12 WeeksN=335
AEs 257 (77)
Grade 3‒4 AE 14 (4)
Serious AE 8 (2)*
Treatment D/C due to AE 0
Death 1 (<1)†
Grade 3‒4 laboratory abnormality
36 (11)
LDV/SOF for 12 Weeks in HIV/HCV Coinfection ION‐4: Safety
Naggie S, et al. CROI 2015.
Patients, n (%)
LDV/SOF 12 WeeksN = 335
Headache 83 (25)
Fatigue 71 (21)
Diarrhea 36 (11)
Nausea 33 (10)
Arthralgia 22 (7)
Upper respiratory tract infection 18 (5)
27
■ Standard DCV dose is 60 mg daily– Dose-adjusted for concomitant ARV therapy: – 30 mg with ritonavir-boosted PIs, – 90 mg with NNRTIs except RPV
DCV 30/60/90 mg +SOF 400 mg QD
24
DCV 30/60/90 mg +SOF 400 mg QD
12
NaiveRandomize 2:1
Experienced
DCV 30/60/90 mg + SOF 400 mg QD
Week 0 8
N
101
50
52
SVR12*
DCV + SOF for 8 vs.12 Weeks in GT 1‐6 HIV/HCV Coinfection ALLY‐2: Study Design
Wyles D, et al. CROI 2015.
ALLY-2: SVR12
GT 1 (N = 168)
DCV + SOF for 8 vs.12 Weeks in GT 1‐6 HIV/HCV Coinfection ALLY‐2: Efficacy GT 1
Wyles D, et al. CROI 2015.
28
DCV + SOF for 12 Weeks in GT 1‐6 HIV/HCV Coinfection ALLY‐2: Efficacy GT 1 – 4
Wyles D, et al. CROI 2015.
Event, n (%) 12-Week GroupsN = 153
8-Week GroupN = 50 Total
Deathsa 0 1 (2) 1 (0.5)
Serious AEsb 4 (3) 0 4 (2)
AEs leading to discontinuation 0 0 0
Opportunistic infections 0 0 0
Grade 3 or 4 lab abnormalities
INR > 2.0 x ULN 2 (1) 0 2 (1)
ALT > 5.0 x ULN 0 0 0
AST > 5.0 x ULN 0 1 (2) 1 (0.5)
Total bilirubin > 2.5 x ULNc 7 (5) 1 (2) 8 (4)
a One death of 52 year-old male with cardiac arrest at posttreatment Week 4 (not related to study therapy).
DCV + SOF for 12 Weeks in GT 1‐6 HIV/HCV Coinfection ALLY‐2: Efficacy GT 1 ‐ 4
Wyles D, et al. CROI 2015.
29
Event, n (%) 12-Week GroupsN = 153
8-Week GroupN = 50 Total
Deathsa 0 1 (2) 1 (0.5)
Serious AEsb 4 (3) 0 4 (2)
AEs leading to discontinuation 0 0 0
Opportunistic infections 0 0 0
Grade 3 or 4 lab abnormalities
INR > 2.0 x ULN 2 (1) 0 2 (1)
ALT > 5.0 x ULN 0 0 0
AST > 5.0 x ULN 0 1 (2) 1 (0.5)
Total bilirubin > 2.5 x ULNc 7 (5) 1 (2) 8 (4)
a One death of 52 year-old male with cardiac arrest at posttreatment Week 4 (not related to study therapy).
DCV + SOF for 12 Weeks in GT 1‐6 HIV/HCV Coinfection ALLY‐2: Efficacy GT 1 ‐ 4
Wyles D, et al. CROI 2015.
3D + RBV in GT 1 HCV/HIV CoinfectionTURQUOISE‐I: Study Design
3D + RBV (n = 32)
3D + RBV (n = 31)
SVR12Open-label Treatment
SVR12
Day 1 Week 12 Week 24 Week 36
Key Eligibility Criteria: HCV GT1 infection, HCV treatment‐naïve or PEG/RBV‐experienced, Child‐Pugh A cirrhosis allowed, stable HIV‐1 infection on ATV or RAL‐inclusive ART regimen
Sulkowski MS, et al. JAMA. 2015 Feb 23. [Epub ahead of print].
30
100%97%
94% 94%100%
97%94%
91%
0%
20%
40%
60%
80%
100%
RVR EOTR SVR4 SVR12
% P
atie
nts
3D + RBV 12-week 3D + RBV 24-week
(Week 4) (Week 12 or 24)
31/31 32/32 30/31 31/32 29/31 30/32 29/31 29/32
3D + RBV in GT 1 HCV/HIV CoinfectionTURQUOISE‐I: Efficacy
Sulkowski MS, et al. JAMA. 2015 Feb 23. [Epub ahead of print].
Summary: HIV and Hepatitis Coinfection
•HIV accelerates HCV liver disease if HIV RNA pos.
* Accelerated fibrosis progression * accel. cirrhosis liver failure * accel. liver failure death
31
Summary: HIV and Hepatitis Coinfection
•HIV accelerates HCV liver disease if HIV RNA pos.
* Accelerated fibrosis progression * accel. cirrhosis liver failure * accel. liver failure death
• HCC is on rise on HIV+ pts.
* discrepant data on survival vs. HIV- pts. * HIV viral load correlates with survival * Screening with better survival * High survival with OLT
Summary: HIV and Hepatitis Coinfection
•HIV accelerates HCV liver disease if HIV RNA pos.
* Accelerated fibrosis progression * accel. cirrhosis liver failure * accel. liver failure death
• HCC is on rise on HIV+ pts.
* discrepant data on survival vs. HIV- pts. * HIV viral load correlates with survival * Screening with better survival * High survival with OLT
• High efficacy of DAA combinations in HIV/HCV with good tolerability