1 / 17

Laurence Brunet,

A longitudinal analysis of liver fibrosis progression among NNRTI and PI users in the Canadian co-infection cohort study. Laurence Brunet, Erica E. M. Moodie , Jim Young ,Sharon Walmsley , Mark Hull, Curtis Cooper, Marina B. Klein IAS 2015 21 July 2015. Background. HIV-HCV co-infection.

dparkinson
Download Presentation

Laurence Brunet,

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A longitudinal analysis of liver fibrosis progression among NNRTI and PI users in the Canadian co-infection cohort study Laurence Brunet, Erica E. M. Moodie, Jim Young,SharonWalmsley, Mark Hull, Curtis Cooper, Marina B. Klein IAS 2015 21 July 2015

  2. Background

  3. HIV-HCV co-infection • 20-30% of HIV+ are co-infected • HCV can be cured • Only effective intervention to prevent liver diseaseprogression • Very few have access to treatment • Combination antiretroviral therapy (cART) • Used by majority • Life-long treatment

  4. ART and the liver • Studies are limited • Short-term/acute toxicity vs. long-term/cumulative toxicity • Inclusion of hepatotoxic backbones (e.g. DDI) • Non-nucleoside reverse transcriptase inhibitors (NNRTI): • Nevirapine associated with hepatotoxicity, fibrosis & clinical liver outcomes • No association between efavirenz and liver outcomes • Protease inhibitors (PI): • Liver steatosis • Lower risks of fibrosis & cirrhosis, slower fibrosis progression rates • Comparison group: treatment naïve or mono/dual-therapy with NRTI

  5. Research objective • Estimating the rate of change in a marker of liver fibrosis among new users of two classes of anchor agents for cART

  6. Methods

  7. Canadian Co-infection Cohort Study

  8. New user design CCC participants N=1321 • No chronic HCV infection (n=216) • Not on 1st anchor class (n=334) • On HCV treatment (n=23) • Not on PI or NNRTI (n=192) • Not on recommended backbone (n=177) • Not on 1st line anchor agent (n=21) • Hepatitis B infection (n=8) Unmatched sample N=348 • Unmatched NNRTI users (n=9) • Unmatched PI users (n=25) Matched sample N=314 N=628 including repeats

  9. Liver fibrosis • APRI score • Aspartate aminotransferase to platelet ratio • Validated in co-infected populations • Accuracy comparable to other markers • Continuous score • Predicts overall five-year survival in HCV infected persons (HR: 2.8, 95% CI: 1.6, 4.7) • Predicted by known predictors of liver disease

  10. Statistical analysis • Rates of change in APRI score by class of anchor agent and backbone • Linear regression with generalized estimating equations • Outcome: Ln(APRI) • Covariates: • Baseline: age, sex, time since HCV infection • Time updated: alcohol use, CD4 count, HIV viral load<50 copies/ml

  11. Results

  12. Population characteristics

  13. Median rates of change in APRI score per 5 years by regimen 1.5 Significant liver fibrosis 1.08 (0.97, 1.19) 1.03 (0.93, 1.12) 1.16 (1.04, 1.29) 1.11 (1.02, 1.20) PI + ABC/3TC PI + TDF/FTC NNRTI + ABC/3TC NNRTI + TDF/FTC

  14. Take home message • 1st study restricted to modern cART regimens • Fibrosis development more influenced by backbone than class of anchor agent • ABC/3TC associated with changes in APRI score over time • Study not designed to look at backbone specifically • Findings need to be confirmed • WHO guideline for cART initiation (all populations): EFV + TDF + (3TC or FTC)

  15. Acknowledgments • The participants of HIV-HCV Canadian Cohort (CTN 222) • The Co-Investigators, Drs. Jeff Cohen, Brian Conway, Curtis Cooper, Pierre Côté, Joseph Cox, John Gill, David Haase, Shariq Haider, Marianne Harris, Mark Hull, Lynn Johnston, Valerie Martel-Laferriere, Julio Montaner, Erica Moodie, Neora Pick, Anita Rachlis, Danielle Rouleau, Aida Sadr, Stephen Sanche, Roger Sandre, Mark Tyndall, Marie-Louise Vachon, Sharon Walmsley, David Wong • We thank Brenda Beckthold, Claire Casavant, Isabelle Chabot, Warmond Chan, Jonathan Edwin, Elaine Fernandez, Claude Gagne, Marcela Gil, Heather Haldane, Judy Latendre-Paquette, Nancy McFarland, Jennifer Kocilowicz, Anja Mcneil, Mitra Motamedi, Renee Pugsley, Laura Puri for their assistance with study coordination, participant recruitment and care • The funding agencies: CIHR, FRSQ and CTN

  16. Thank you! Questions?

More Related