AASLD 2009: Study Looks at Factors Affecting Survival of HIV/HCV Coinfected Liver Transplant Recipients

While HIV/HCV coinfected patients can have good outcomes after liver transplantation, acute organ rejection remains a risk factor and survival does not match that of HIV negative people with hepatitis C virus (HCV) alone, according to a study presented at the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009) this month in Boston.

Read more:

Rapid Liver Fibrosis Progression and Successful Treatment of Acute Infection Suggest Benefits of Routine HCV Screening for HIV Positive Men

Researchers from Mt. Sinai School of Medicine presented data last week at the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) in Boston that further characterize a cohort of HIV positive men with apparently sexually transmitted acute hepatitis C virus (HCV) infection. This group continues to experience more rapid than expected liver fibrosis progression. Hepatitis C treatment has been highly successful if started during the acute phase, but less so thereafter. The researchers recommended routine ALT and HCV antibody testing to allow for prompt treatment and to prevent liver disease progression.alt

Read more:

New HCV Infection Is Occurring among HIV Positive U.S. Men, ACTG Analysis Shows

The incidence of hepatitis C virus (HCV) infection may be increasing among HIV positive men in the U.S., according to an analysis of participants in several AIDS Clinical Trial Group (ACTG) studies presented this past weekend at the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009) in Boston. Only 25% reported injection drug use, suggesting that non-parenteral routes (for example, sexual transmission) play a significant role.

Read more:

AASLD 2009: Boosted Narlaprevir plus Pegylated Interferon and Ribavirin Leads to Rapid Viral Suppression in Genotype 1 Hepatitis C Patients

In the NEXT-1 study, presented at the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009) last week in Boston, the experimental HCV NS3 protease inhibitor narlaprevir (formerly SCH 900518), boosted with ritonavir, demonstrated potent antiviral activity in combination with pegylated interferon and ribavirin among treatment-naive patients with genotype 1 chronic hepatitis C. Across the doses tested, 53% to 87% of narlaprevir recipients achieved undetectable HCV RNA by week 4. Nalraprevir/ritonavir demonstrated no unique or treatment-limiting adverse effects.

Read more:

CROI 2008: Rapid Liver Fibrosis Progression in HIV Positive Men with Acute HCV Infection

In recent years there have been reports of several outbreaks of apparently sexually transmitted acute hepatitis C among mostly HIV positive men who have sex with men (MSM) in European cities and Australia. These cases are notable because the patients were known to already be infected with HIV when they acquired HCV (typically HCV is acquired first).

Several studies have shown that HIV-HCV coinfected individuals with chronic hepatitis C tend to experience more rapid liver fibrosis progression. But little is known about the effect of HIV on liver disease in people with acute HCV infection.

At the 2007 Conference on Retroviruses and Opportunistic Infections (CROI) last February, Daniel Fierer and colleagues from Mt. Sinai School of Medicine in New York City presented early data from a prospective study of HIV positive MSM with acute HCV infection, defined as the first 6 months after HCV infection. The researchers considered a combination of 3 criteria as indicators of acute hepatitis C: recent seroconversion to HCV antibody positive status, marked elevations in serum alanine aminotransferase (ALT) level, and wide fluctuations in HCV viral load.

Study participants underwent liver biopsy within 4 months of the first-noted ALT elevation. Fibrosis was staged using the Scheuer system, on a scale of 0 to 4. Fibrosis progression rate (FPR) was calculated by dividing the fibrosis stage by the interval between the dates of the recent ALT elevation and the biopsy.

As previously reported, among the first 5 enrolled patients, 4 already had moderate portal fibrosis during acute hepatitis C. At this year’s CROI, taking place this week in Boston, the researchers presented a poster describing further data from more study participants.

Results

  • Of the 11 patients who underwent liver biopsy, 9 did so within 4.5 months of detection of ALT elevation, and 2 within 16 months.
  • Despite the short duration of HCV infection, 9 of the 11 (82%) had stage 2 fibrosis and 1 had stage 1 fibrosis.
  • The mean FPR in these 11 patients was 4.5 (± 3.3) units per year.
  • No causes of liver damage other than acute HCV infection were identified.
  • In the analysis of risk factors for HCV acquisition, only 4 patients reported even a single episode of intravenous drug use.
  • However, non-injection drug use and high-risk sexual behavior were common.
  • 7 reported club drug (including methamphetamine) use and 10 reported unprotected anal intercourse with multiple partners.

Based on these findings, the researchers concluded, “Acute HCV infection of MSM with underlying HIV infection resulted in early and rapid progression of liver fibrosis, with FPR rates far in excess of other settings of HCV infection.”

“Many of these HIV-infected men with acute HCV used non-injection drugs and had unprotected sex with multiple partners,” they continued. “Some appear to have become HCV-infected via sexual activity.”

The investigators recommended that, “More intensive prevention and screening strategies for acute HCV in MSM are needed,” and “further research is needed to identify the disease processes leading to this highly accelerated liver injury.”

Mt Sinai School of Medicine, New York, NY.

2/5/08

Reference

D Fierer, A Uriel, D Carriero, and others. An Emerging Syndrome of Rapid Liver Fibrosis in HIV-infected Men with Acute HCV Infection. 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA. February 3-6, 2008. Abstract 1050.