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Interferon‐free regimens improve portal hypertension and histological necroinflammation in HIV / HCV patients with advanced liver disease
Author(s) -
Schwabl P.,
Mandorfer M.,
Steiner S.,
Scheiner B.,
Chromy D.,
Herac M.,
Bucsics T.,
Hayden H.,
GrabmeierPfistershammer K.,
Ferlitsch A.,
Oberhuber G.,
Trauner M.,
PeckRadosavljevic M.,
Reiberger T.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13844
Subject(s) - medicine , portal venous pressure , transient elastography , gastroenterology , portal hypertension , cirrhosis , liver disease , steatosis , hepatitis c , hepatitis c virus , ascites , fibrosis , immunology , liver fibrosis , virus
Summary Background HIV / HCV co‐infected patients show accelerated fibrosis progression and higher risk for complications of portal hypertension ( PHT ). Aim To assess the effects of interferon‐free therapy on portal pressure, liver histology and plasma biomarkers in HIV / HCV ‐coinfected patients with PHT . Methods Twenty‐two patients with paired hepatic venous pressure gradient ( HVPG ) measurements prior and after successful treatment ( SVR ) with interferon‐free regimens were included. Liver stiffness was assessed by transient elastography and biopsies were scored according to METAVIR . Plasma biomarkers were determined by ELISA . Results Overall, HVPG decreased from 10.7 ± 4.1 mmHg at baseline to 7.4 ± 4.2 mmHg after HCV treatment (Δ:‐3.3 ± 2.7 mmHg; p < 0.001). In patients with clinically significant PHT ( HVPG ≥10 mmHg, n = 11), HVPG decreased from 14.1 ± 2.9 to 10.4 ± 3.9 mmHg (Δ:‐3.7 ± 3.3 mmHg; p = 0.004) and a haemodynamic response ( HVPG decrease ≥10%) was observed in 73%. In 64% of patients with subclinical PHT ( HVPG 6–9 mmHg, n = 11), portal pressure normalised at SVR . Mean liver stiffness decreased from 20.8 kPa to 11.5 kPa (Δ:‐8.8 ± 7.4 kPa; p < 0.001). Fifty percent (7/14) of patients with cirrhosis were re‐classified as METAVIR ≤F3 and all patients with decompensated cirrhosis improved their Child–Pugh stage. After successful HCV treatment, 39% still had persistent histological necroinflammatory activity ( METAVIR A1), which correlated with less HVPG response and more steatosis. While most biomarkers improved with SVR , METAVIR A1 patients had significantly higher plasma levels of fibrogenic ( PDGF , TGF ‐β) and angiogenic ( VEGF , Angiopoietin1) biomarkers. Conclusions Interferon‐free therapy reduces PHT and halts histological necroinflammatory activity in the majority of HIV / HCV ‐coinfected patients after SVR , which may lead to re‐compensation of liver function in cirrhosis. Biomarkers could identify patients with persisting hepatic necroinflammation.