Improvements to liver after Hepatitis C cure could be impacted by HIV treatment choice

According to a report in the Journal of Antimicrobial Chemotherapy, people living with HIV who have been cured of Hepatitis C (HCV) will experience a greater reduction in liver stiffness if their HIV treatment regimen includes a non-nucleoside reverse transcriptase inhibitor (NNRTI).

Liver stiffness, a marker of fibrosis, which is measured through a fibroscan is a way of identifying people who remain at higher risk of liver complications after their HCV has been cured. A fibroscan result of 14 kilopascals or above indicates severe cirrhosis or liver damage.

We know that curing HCV with direct-acting antiretroviral treatment (DAA) can result in improvements in liver health and condition as long as the liver damage is not too advanced at time of starting treatment. Spanish researchers have been investigating whether a person’s HIV antiretroviral therapy (ART) impacted liver regeneration after that person achieved an HCV cure.

The team recruited 313 participants who:

• Were HIV positive and receiving ART
• Had been cured of HCV by DAA
• Had received a fibroscan result of <9.5kPA before starting DAA

Of the 313 participants, 74 were on a HIV regimen that included an NNRTI (RPV or EFZ) and 239 were on a regimen that contained two nucleoside reverse transcriptase inhibitors (NRTI) and an integrase inhibitor or a protease inhibitor (with or without booster). Both groups were similar in age and gender. Median liver stiffness was 16.7kPa in the NNRTI group and 17.3kPa in the NRTI group.

It is worth noting that the NNRTI group had a higher median CD4 count (665 versus 527), had a higher proportion of undetectable viral loads (95% versus 80%) and had much lower reported alcohol consumption than the NRTI group.

After completion of their HCV DAA treatment those taking a HIV regimen including an NNRTI saw a greater reduction in liver stiffness (35%) compared to those taking an NRTI regiment (29%) (p=0.018).

Analysis of all the data, controlled for factors such as age, gender, HCV genotype, NRTI choice, showed that NNRTI treatment was the standout factor apart from HCV genotype 3 that was associated with a reduction in liver stiffness.

Further sub-analysis of those participants with cirrhosis at admission (a fibroscan score of 14kPa or above) showed “no signification advantage” to a NNRTI based HIV treatment regimen.

The research team say that using NNRTIs for the treatment of people living with HIV after HCV cure may speed up liver regeneration by encouraging apoptosis (programmed cell death). The team has called for further research on the topic.