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Incidence and Progression to Cirrhosis of HCV Superinfection in Persons Living with HIV (PLHIV): accelerated progression risk 'not as dramatic'
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Reported by Jules Levin
CROI 2013
Massimo Puoti*1, Patrizia Lorenzini2, Enrico Girardi2, Alessandro Cozzi-Lepri3, Andrea Gori4, Claudio Mastroianni5, Giuliano Rizzardini6, Giovanni Mazzarello7, Andrea Antinori2, Antonella d'Arminio
Monforte8, and Icona Foundation Study Group1
Niguarda Ca' Granda Hosp, Milano, Italy; 2National Inst. Infectious Dis. "Lazzaro Spallanzani", Rome, Italy; 3University College London, London, UK; 4San Gerardo de' Tintori Hosp, Monza, Italy; 5"La Sapienza" Rome University Polo Pontino, Latina, Italy; 6Luigi Sacco
Hosp, Milano, Italy; 7San Martino Hosp., Genova, Italy; and 8University of Milano, San Paolo Hospital, Milano Italy
"5 years probability of the progression to cirrhosis was 5.2% and 9 years
was 11%."
"Incidence of seroconversion significantly decreased over time from 1997 to 2010
in all risk groups except MSM (IR in 1997-2001 vs 2009-2012: 1.8 vs 1.7 in MSM p=0.346; 18.4 vs 2.4 in IDU p<0.001;
2.1 vs 0.1 in heterosexual p<0.001). We observed occurrence of cirrhosis in 16 seroconverters over 1254 PYFU for an
estimated rate of 12.8 per PYFU (95%CI 7.8-20.8).
CONCLUSIONS The incidence of HCV superinfection in Icona cohort was high but declined over time in all groups
except MSM probably because of recent sexually transmitted infections. After HCV superinfection the probability of
progression to cirrhosis of was 11% by 9 years, which is similar to that observed in historical controls of HCV+/HIVnegative
individuals which should reassure patients and caregivers regarding the risk of early cirrhosis in these patients."
ABSTRACT
BACKGROUND There are controversial data about the course of liver fibrosis development following Hepatitis C superinfection in persons living with HIV (PLHIV).
AIM AND METHODS We analyzed HCV seroconverters of PLHIV enrolled in the ICONA Foundation Study in order to estimate the incidence and predictors of HCV superinfection and the risk of progression to cirrhosis. We selected all the subjects with a first negative anti HCV test who performed at least a second anti HCV test and estimated the incidence of HCV seroconvertion and determined predictors by Poisson regression. We selected patients who experienced HCV superinfection and defined the probability of progression to cirrhosis as the occurrence of liver related death, liver decompensation, clinical diagnosis of cirrhosis or a FIB4 > 3.25 whatever occurred first using Kaplan Meier method.
RESULTS. We identified 2517 patients with a negative anti HCV test who performed at least a second test; in 207 people this second test was positive (seroconverters) over a total of 17378 patients years; the estimated Incidence rate (IR) of HCV superinfection was 1.2 per 100 person years of follow-up (PYFU) (95% CI 1.0-1.4). IDU (AIR vs. heterosexuals 4.58; 95% CI 1.44-14.59 p=0.010), being a MSM (AIR 2.53 vs. heterosexuals 95% 1.07-6.02 p=0.035) lower level of education (primary school) (AOR vs. high school or degree 2,47 95% CI 0.99-6.17 p=0.052), place of residence (central Italy (AOR vs north Italy 1.98 95% CI 1.1-3.56 p=0.023) were significantly associated with an increased risk of seroconversion in multivariable analysis. Incidence of seroconversion significantly decreased over time from 1997 to 2010 in all risk groups except MSM (IR in 1997-2001 vs 2009-2012: 1.8 vs 1.7 in MSM p=0.346; 18.4 vs 2.4 in IDU p<0.001; 2.1 vs 0.1 in heterosexual p<0.001). We observed occurrence of cirrhosis in 16 seroconverters over 1254 PYFU for an estimated rate of 12.8 per PYFU (95%CI 7.8-20.8).
CONCLUSIONS The incidence of HCV superinfection in Icona cohort was high but declined over time in all groups except MSM probably because of recent sexually transmitted infections. After HCV superinfection the probability of progression to cirrhosis of was 11% by 9 years, which is similar to that observed in historical controls of HCV+/HIV-negative individuals which should reassure patients and caregivers regarding the risk of early cirrhosis in these patients.
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