In our urban clinic a significant number of HCV patients (pts) have not received HCV treatment, primarily due to insurance restrictions. Among treated pts, data on post cure fibrosis regression in HIV/HCV coinfection are sparse. We evaluated changes in fibrosis as measured by liver elastography (TE) to assess the impact of HCV treatment.
Methods:All HCVRNA+ patients with >2 TEs performed as part of routine care at the Ruth M. Rothstein CORE center, Chicago from April 2014to April 2016 were analyzed. HCV treatment status was identified for all pts. Mann Whitney and Fisher’s exact tests were used to determine differences in TE scores in follow up scans between the treated and untreated pts.
Results: Among 232 total pts (76% genotype 1) 182(78%) had no Rx and 50(22%) were treated after the baseline scan. Median age was 57 years, 69% were male, 67% African American, 16% Caucasian and 15% Hispanic. No significant differences were found in age, gender, race or HCV genotype between treated and untreated pts. Pts who were treated were more likely to be HIV+ (86% vs 58%; p<0.001) and had more significant fibrosis (F3 or F4); 76% vs 25% (p <0.001). 56% of treated pts were cirrhotic at baseline. Among treated pts; 46 (92%) achieved SVR12, the 4 relapsers were cirrhotic; 2 treatment experienced. Among untreated pts, female sex and baseline fibrosis F3 were associated with fibrosis progression (P=0.002). Change in fibrosis scores by Rx status are in table 1.
Conclusion: HCV treatment was the greatest predictor of fibrosis regression in our cohort with the majority of the treated pts patients improving >1 fibrosis stage on follow up. Fibrosis progression >1 stage was significantly increased in untreated pts over a median of 10 months with baseline significant fibrosis associated with progression. These results underscore the pathophysiological benefit of treatment for patients with chronic HCV and further highlights the need for policies to enable treatment for a greater number of patients, especially those belonging to vulnerable populations.
C. Winston, None
D. Taussig, None
B. Go, None
S. Vibhakar, None
R. Golberg, None
G. Huhn, None