Long-term liver stiffness dynamics after sustained virological response in patients with HIV/HCV co-infection and advanced fibrosis

Abstract

Objective: This study analyses liver stiffness (LS) dynamics in people with HIV (PWH) and advanced liver fibrosis who achieved sustained virological response (SVR) and assess factors associated with LS normalization or progression, after long-term follow-up.

Design: Prospective multicenter cohort study.

Methods: This study included individuals with HIV/HCV co-infection from the Spanish GEHEP-011 cohort, fulfilling: pretreatment LS ≥9.5 kPa; sustained virological response (SVR) with direct-acting antiviral regimen; available measurement of LS at SVR. Factors associated with LS normalization (achieving ≤7.2 kPa in two consecutive measurement) and progression (increase of >20% LS at the last measurement available) were analyzed.

Results: A total of 678 patients were included. The median follow-up was 40 (17-71) months. The repeated measures ANOVA revealed a significant main effect of time on LS. Overall, 221 (32.6%) achieved normalization. Lower probability of normalization was associated with advanced liver disease [baseline LS: sHR = 0.26 (95% CI, 0.19-0.37), P < 0.001; liver decompensation before SVR: sHR = 0.22 (0.05-0.97), P < 0.001; baseline MELD score: sHR = 0.81 (0.69-0.94), P = 0.006]. LS progression occurred in 50 (7.4%). Progression was associated with higher baseline LS [sHR = 1.04 (1.01-1.07), P = 0.007], controlled attenuation parameter (CAP) [CAP ≥ 280 dB/m: sHR = 2.94 (1.16-7.44)] and older age [sHR 1.06 (1.00-1.13), per year, P = 0.04].

Conclusions: In PWH, LS significantly decreases after HCV cure in the long-term, achieving values of ≤7.2 kPa. In a substantial proportion of patients, LS remain stable or even increases. Older age and concomitant steatotic liver disease are associated with LS progression.

Keywords: HIV/HCV co-infection; liver stiffness; sustained virological response; transient elastography.