Liver fibrosis assessment and treatment initiation within a systematic screening program among HIV/HIV-coinfected patients
16 May 2017 (online)
Background & Aim:
HCV therapy should be considered without delay in all patients with significant (SIGFIB) or advanced liver fibrosis (ADVFIB). We aimed to investigate whether FIB-4 index is a valid screening tool for the identification of HIV/HCV-coinfected patients (HIV/HCV) with SIGFIB or ADVFIB. Moreover, we assessed the rate of treatment initiation with IFN-free regimens within this screening program.
FIB-4 was calculated in all HIV/HCV from 2014 – 2016. HIV/HCV were counseled by the HIV clinic and referred to the HIV&Liver clinic of the Division of Gastroenterology and Hepatology for liver fibrosis assessment by transient elastography (TE) and evaluation for HCV therapy. Patients were stratified according to a FIB-4 of 1.45 (established cut-off for ruling out ADVFIB). SIGFIB/ADVFIB were defined by liver stiffness > 7.1kPa/> 9.5kPa, respectively.
Among 1348 HIV+ patients, 16%(210/1348) had detectable serum HCV-RNA. The majority of HIV/HCV (57%) had HCV-genotype 1 (1a: 74%/1b: 26%), while HCV-genotypes 2, 3, and 4 were observed in 2%, 31%, and 10% of patients.
One hundred HIV/HCV had a FIB-4 index ≥1.45. Among these, 57%(57/100) underwent TE. The majority of these patients had SIGFIB (75%; 43/57) or ADVFIB (37%; 21/57), however, interferon-free treatments were initiated in only 56%(24/43).
In addition, fifty-two percent (57/110) of HIV/HCV with FIB-4 index < 1.45 underwent TE. Interestingly, 40%(23/57) and 18%(10/57) of these patients showed SIGFIB or even ADVFIB, respectively, and 78%(18/23) finally received interferon-free treatment.
Overall, only 20%(42/210) of HIV/HCV received interferon-free treatment.
FIB-4 was not useful for ruling out ADVFIB in our cohort of HIV/HCV. Treatment was initiated only in a small proportion of HIV/HCV during the first two years of IFN-free treatment availability, although the observed proportion of patients with SIGFIB (assessed by TE) was considerably higher (58%). Thus, it requires the ongoing combined efforts of both HIV and HCV specialists to increase treatment uptake rates in this special population.