Impact of HIV infection on the dynamics of liver stiffness in patients with hepatitis C virus chronic infection after sustained virological response

Abstract

Background: After sustained virological response (SVR), liver stiffness (LS) usually decreases. However, information related to the impact of HIV co-infection in patients with advanced fibrosis is scarce. The aim was to analyze the impact of HIV co-infection on the LS dynamics after HCV cure. Methods: Prospective study conducted in the GEHEP-011 multicenter cohort (initiated in October 2011–November 2023, ID NCT04460157), including patients with chronic HCV infection, with or without HIV co-infection, fulfilling: 1) SVR with direct-acting antivirals; 2) pre-treatment LS ≥ 9.5 kPa; 3) available measurement of LS at SVR. Pre-treatment, SVR and annual post-treatment LS were assessed. The primary outcome was time to LS normalization achievement (≤7.2 kPa) in two consecutive examinations. Findings: 1138 patients were included, 678 (60%) of whom were living with HIV (PLWH). The median time between the first to the last measure was 35 (17–69) months. In total, 390 [34% (95% confidence interval, 31%–37%)] patients achieved LS normalization, 169 [37% (CI 95%, 34%–43%)] individuals with HCV mono-infection vs. 221 [32% (CI 95%, 29%–36%)] PLWH achieved LS normalization (p = 0.003). The propensity score (PS) for HIV infection was calculated. In a multivariate model for competing risks (death was the competing event) adjusted for HIV, PS and diabetes, HIV infection was associated with a lower probability of achieving normalization [sHR = 0.82 (95% CI, 0.67–1.00), p = 0.045]. Matching by closer PS was performed. In the resultant subset, the probability of achieving LS normalization was again lower in PLWH [sHR = 0.76 (0.56–0.97), p < 0.001]. Interpretation: After SVR, the probability of reaching LS normalization is significantly lower in PLWH. This could have implications on the development of long-term clinical events. Funding: Project PI19/01443, ERDF/ESF “Investing in your future”, GLD21_00096, GEHEP-011 project, B-0061-2021, JR24/00044, A1-0060-2021, CM23/00255, CM22/00176.