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The Case for Treatment Now

The Case for Treatment Now. Todd Wills, MD ETAC Infectious Disease Specialist. HEPATITIS C TREATMENT EXPANSION INITIATIVE MULTISITE CONFERENCE CALL JULY 17, 2013. Increases Rates of HCC in HIV/HCV Coinfection.

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The Case for Treatment Now

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  1. The Case for Treatment Now Todd Wills, MD ETAC Infectious Disease Specialist HEPATITIS C TREATMENT EXPANSION INITIATIVE MULTISITE CONFERENCE CALL JULY 17, 2013

  2. Increases Rates of HCC in HIV/HCV Coinfection N Merchante, E Merino, J López-Aldeguer, et al. Increasing Incidence of Hepatocellular Carcinoma in HIV-Infected Patients in Spain. Clinical Infectious Diseases56 (1):143-150. January 1, 2013. Results Among HIV/HCV coinfected participants, HCC incidence rose from 0.2 to 2.8 cases per 1000 person-years between 2000 and 2009, with the largest jump in 2008-2009. Most patients with HCC (79%) died during follow-up, all but 2 due to complications related to liver cancer. The median survival time after HCC diagnosis was 91 days (interquartile range, 31 to 227 days). Compared with cases of HCC diagnosed before 2005, people diagnosed during later years did not have a higher survival rate.

  3. High Risk for Decompensation J Macias, A Camacho, MA von Wichmann, et al. Advanced fibrosis and the risk of liver decompensation among HIV/HCV-coinfected individuals: consequences for the timing of therapy against HCV. 48th Annual Meeting of the European Association for the Study of the Liver (EASL 2013). Amsterdam. April 24-28, 2013. Abstract 474. F3 fibrosis (biopsy), probability of decompensation :1% at 1 year, 2% at 3 years, 5% at 5 years. Among patients with cirrhosis (biopsy), corresponding probabilities were 4%, 13%, and 23%. Among patients with 9.5-14.5 kPa (FibroScan), probability of decompensation : 1% at 1 year, 3% at 3 years, 4% at 5 years. Among patients with >14.6 kPa (FibroScan), the probabilities were 7%, 17%, and 27%, respectively.

  4. HCV Treatment Lowers Risk of Cirrhosis Complications T Poynard, MA Valantin, M Munteanu, et al (FibroFrance-GHPS Group). Long Term Survival of Liver Fibrosis after Virological Cure (SVR) in HIV-HCV Coinfected Patients: A Worrisome Latent Disease?
48th Annual Meeting of the European Association for the Study of the Liver (EASL 2013). Amsterdam. April 24-28, 2013. Abstract 487.. • baseline fibrosis, 10-year survival: • Patients with SVR: HIV/HCV coinfected 66% vs HCV monoinfected 62% (p=0.04); • Untreated: 7% vs 93%, respectively (p=0.009). • Among untreated participants, coinfected were 9 times more likely than HCV monoinfected to progress to cirrhosis over 10 years (1.41 vs 0.18, respectively; p < 0.001).

  5. Acute HCV in MSM on the Rise • Acute HCV in MSM on rise • 17 incident cases (among 2250 subjects) in 5 phase II/III studies of EVG/COBI/FTC/TDF[1] • Observational study assessed HCV reinfections in high-risk HIV/HCV-coinfected MSM (N = 64)[2] • GT1a HCV: 62.5% (n = 40) ─ GT1b HCV: 6.3% (n = 4) • GT3a HCV: 3.1% (n = 2) ─ GT4d HCV: 28.1% (n = 18) • 33 cleared virus spontaneously or following treatment[2] • 5-yr cumulative incidence of new infection by genotype[2] • Same HCV genotype as original infection: 6.1% (95% CI: 0% to 14.5%) • Different HCV genotype than original infection: 25.5% (95% CI: 10.4% to 38.0%) • Results demonstrate continued risk of HCV reinfection after clearance[2] 1. Quirk E, et al. CROI 2013. Abstract 705. 2. Thomas X, et al. CROI 2013. Abstract 708.

  6. Impaired HCV Specific Immune Response in HIV+ Patients • HIV infection had a detrimental effect on HCV-specific cytokine production in people with acute hepatitis C. • The effect was particularly notable for HCV-specific interferon gamma production. • Interferon gamma responses were both significantly lower in magnitude and smaller in breadth in HIV/HCV coinfected people. • Reduced interferon production was associated with lower peripheral CD4 T-cell counts, but not with detectable HIV viral load. JK Flynn, GJ Dore, G Matthews, R Ffrench, et al (ATAHC Study Group). Impaired Hepatitis C Virus (HCV)-Specific Interferon-Responses in Individuals with HIV Who Acquire HCV Infection: Correlation With CD4+ T-Cell Counts. Journal of Infectious Diseases 206(10):1568-1576. November 15, 2012.

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