International workshop on co-infection HIV & Hepatitis - Virology...
Transcript of International workshop on co-infection HIV & Hepatitis - Virology...
13th International workshop on co-infection
HIV & Hepatitis
23 June 2017
Lisbon - Portugal
Authors: Sarmento – Castro R., Marques M., Tavares A., Gonçalves C, Furtado I.,
R. de Valdoleiros S., Vasconcelos O., Seabra J., Méndez J.
New direct antiviral agents (DAAs) are safe and effective in the treatment of
patients with hepatitis C infection.
Few clinical trials included a significant number of cirrhotic co-infected
patients.
In this study, we evaluate the efficacy and safety of DAAs in the treatment of
cirrhotic HCV/HIV co-infected patients in a real life setting.
Prospective study of cirrhotic (TE ≥ 12.5 kPa) HCV/HIV
co-infected patients under HAART
113 patients initiated treatment with DAAs for
12 or 24 weeks
We compared the baseline and SVR12 characteristics
Possible factors associated with SVR12 were
analysed
93,8%
3,5% 2,7% Risk factor
IDU
Sexual
Unknown
Characteristics Value
Mean age 47 years old
Male sex 98 (86.7%)
HIV infection Mean
CD4+/mm3
count
577
Viral load
< 20 cp/ml
107
(95%)
Characteristics Value
Treatment experienced
38 (33.6%)
Transient elastrography (TE)
12.5 -25 kPa
≥ 25 kPa
70 (61,9%)
43 (38.1%)
Endoscopic signs of portal hipertension 22 (19.5%)
MELD mean score 8,7
Child pugh score A 112 (99.1%)
Platelets/µL
< 75 x 103
≥ 75 x 103
19 (16.8%)
94 (83.2%)
Albumin (g/dl)
< 3.5
≥3.5
10 (8.9%)
103 (91.1%)
77%
0,90%
12,40%
9,70%
G1 G2 G3 G4
Mean HCV RNA –
3.835.653 UI/ml
SOF/LDV
SOF/LDV + RBV
SOF + RBV
PEG IFN + RBV+ SOF
SOF/DCV + RBV
3 D´S
SOF+ DCV
50,4%
34,0%
5,3%
3,5%
2,7%
2,7%
1,8%
Without statistically significant differences
[VALOR]%
[VALOR]%
[VALOR]%
[VALOR]%
G1 G2 G3 G4
[VALOR]%
[VALOR]%
Naive Treatmentexperienced
[VALO
R]%
Global
106
113 71
75
35
38
83
87
1
1 12
14
10
11
Albumin
(g/dl)
SVR 12 (% and N)
No Yes
< 3,5 3,6% (4) 5,4% (6)
≥ 3,5 2,7% (3) 88,5% (100)
Total 7 106
Albumin < 3,5 g/dl was
associated with poor SVR12
(p=0.007)
4,32 4,33
4,41
4,45
4,5
Baseline W4 EOT PT4W SVR12
Statiscally significant improvement (p < 0.05)
129.000
145.000
153.214
143950 142405
Baseline W4 EOT PT4W SVR12
Albumin Platelets MELD score
baseline: 8,7
PTW12: 6,2
25,8
21,8 19,1
Baseline EOT SVR12
Statiscally
significant decrease
(p < 0.05)
Five patients decompensated
- Two with encephalopaty
- Two developed hepatocellular carcinoma
- One had variceal bleeding
Patient Genotype IL 28B
Baseline Previous
HCV
treatment
DAAs
combination Outcome
Albumin
(mg/dl)
Child-
Pugh
Score
MELD
score
HCV RNA
(UI/mL)
TE
(KPa)
Platelets
(x103/ ul)
1 1 Unkno
wn 5,14 A
8 4.970.000 26,6
155 Yes
SOF/LDV //
24w Relapse
2 1 Unkno
wn 4,5 A
7
2.400.000 17,6
162
No SOF/LDV //
24w
Lost to
follow up
3 4 Unkno
wn 2,34 A
12
7.190.000 51,4
141
Yes SOF/LDV+RBV
// 24w
Lost to
follow up
Patient Genotype IL
28B
Baseline
Previous
HCV
treatment
DAAs
combination Outcome
Albumin
(mg/dl)
Child-
Pugh
Score
MELD
score HCV RNA
(UI/mL)
TE
(KPa)
Platelets
(x103/ ul)
4 1 CC 3,6 B
11 22500 49,7
119 Yes
SOF/LDV+RBV
// 24w
Died
(encephal
opathy)
5 1 CT 3,5 A 7
6.100.000 15,3 227 No SOF/LDV+RBV
// 12w
Died
(AMI)
6 3 CC 3,30 A 10
1.370.000 36 102 No SOF/LDV + RBV
// 24w
Died
(HCC)
7 3 CT 3,37 A
11 153.000 47,2 61 No SOF/DCV // 24w
Died
(Acute GI
bleeding)
SVR was achived in 93.8% of HCV/HIV cirrhotic patients.
Liver function had a significant improvement during the
treatment with DAAs (MELD score, liver fibrosis, platelets
and albumin).
Lower level of albumin was significantly associated with
poor SVR 12.
Rui Sarmento e Castro
Josefina Méndez
Ana Horta
Ana Paula Tavares
João Seabra
Olga Vasconcelos
Miguel Araújo
Maria João Gonçalves
Celina Gonçalves
Isabel Furtado
Cristina Soeiro
Maria José Santos
13th International workshop on co-infection
HIV & Hepatitis
23 June 2017
Lisbon - Portugal