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Liver function following hepatitis C virus eradication by direct acting antivirals in patients with liver cirrhosis: data from the PITER cohort

  • Quaranta, Maria Giovanna1
  • Ferrigno, Luigina1
  • Tata, Xhimi2
  • D’Angelo, Franca1
  • Coppola, Carmine3
  • Ciancio, Alessia4
  • Bruno, Serena Rita5
  • Loi, Martina6
  • Giorgini, Alessia7
  • Margotti, Marzia8
  • Cossiga, Valentina9
  • Brancaccio, Giuseppina10
  • Dallio, Marcello11
  • De Siena, Martina12
  • Cannizzaro, Marco13
  • Cavalletto, Luisa14
  • Massari, Marco15
  • Mazzitelli, Maria16
  • De Leo, Pasqualina17
  • Laccabue, Diletta18
  • And 2 more
  • 1 Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy , Rome (Italy)
  • 2 University of Tor Vergata, Nostra Signora del Buon Consiglio di Tirana, Tirana, Albania , Tirana (Albania)
  • 3 Gragnano Hospital, Naples, Italy , Naples (Italy)
  • 4 University of Turin, Turin, Italy , Turin (Italy)
  • 5 Infectious Diseases, Ospedali Riuniti, Foggia, Italy , Foggia (Italy)
  • 6 University Hospital, Monserrato, Cagliari, Italy , Cagliari (Italy)
  • 7 San Paolo Hospital, University of Milan, Milan, Italy , Milan (Italy)
  • 8 University Hospital of Modena, Modena, Italy , Modena (Italy)
  • 9 Federico II University, Naples, Italy , Naples (Italy)
  • 10 University of Padua, Padua, Italy , Padua (Italy)
  • 11 University of Campania Luigi Vanvitelli, Naples, Italy , Naples (Italy)
  • 12 Università Cattolica del Sacro Cuore, Rome, Italy , Rome (Italy)
  • 13 Villa Sofia-Cervello Hospital, Palermo, Italy , Palermo (Italy)
  • 14 University Hospital of Padua, Padua, Italy , Padua (Italy)
  • 15 Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy , Reggio Emilia (Italy)
  • 16 University Hospital Mater Domini, Catanzaro, Italy , Catanzaro (Italy)
  • 17 San Paolo Hospital, Savona, Italy , Savona (Italy)
  • 18 Azienda Ospedaliero-Universitaria di Parma, Parma, Italy , Parma (Italy)
  • 19 University of Tor Vergata, Rome, Italy , Rome (Italy)
Published Article
BMC Infectious Diseases
Springer (Biomed Central Ltd.)
Publication Date
May 04, 2021
DOI: 10.1186/s12879-021-06053-3
Springer Nature


BackgroundThe development of direct-acting antivirals (DAA) for HCV has revolutionized the treatment of HCV, including its treatment in patients with HIV coinfection. The aim of this study was to compare the changes in liver function between coinfected and monoinfected patients with cirrhosis who achieved HCV eradication by DAA.MethodsPatients with pre-treatment diagnosis of HCV liver cirrhosis, consecutively enrolled in the multicenter PITER cohort, who achieved a sustained virological response 12 weeks after treatment cessation (SVR12) were analysed. Changes in Child-Pugh (C-P) class and the occurrence of a decompensating event was prospectively evaluated after the end of DAA treatment. Cox regression analysis was used to evaluate factors independently associated with changes in liver function following viral eradication.ResultsWe evaluated 1350 patients, of whom 1242 HCV monoinfected (median follow-up 24.7, range 6.8–47.5 months after viral eradication) and 108 (8%) HCV/HIV coinfected (median follow-up 27.1, range 6.0–44.6).After adjusting for age, sex, HCV-genotype, HBsAg positivity and alcohol use, HIV was independently associated with a more advanced liver disease before treatment (C-P class B/C vs A) (OR: 3.73, 95% CI:2.00–6.98). Following HCV eradication, C-P class improved in 17/20 (85%) coinfected patients (from B to A and from C to B) and in 53/82 (64.6%) monoinfected patients (from B to A) (p = 0.08). C-P class worsened in 3/56 coinfected (5.3%) (from A to B) and in 84/1024 (8.2%) monoinfected patients (p = 0.45) (from A to B or C and from B to C).Baseline factors independently associated with C-P class worsening were male sex (HR = 2.00; 95% CI = 1.18–3.36), platelet count < 100,000/μl (HR = 1.75; 95% CI 1.08–2.85) and increased INR (HR = 2.41; 95% CI 1.51–3.84). Following viral eradication, in 7 of 15 coinfected (46.6%) and in 61 of 133 (45.8%) monoinfected patients with previous history of decompensation, a new decompensating event occurred. A first decompensating event was recorded in 4 of 93 (4.3%) coinfected and in 53 of 1109 (4.8%) monoinfected patients (p = 0.83).ConclusionsImprovement of liver function was observed following HCV eradication in the majority of patients with cirrhosis; however viral eradication did not always mean cure of liver disease in both monoinfected and coinfected patients with advanced liver disease.

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