2147. The Natural History of FIB-4 Score Progression among HIV/HCV co-infected Adults in an Outpatient Clinic
Session: Poster Abstract Session: HIV/HCV Coinfection and Liver Disease
Saturday, October 29, 2016
Room: Poster Hall
Background: Studies have documented more rapid progression of HCV-associated liver fibrosis in patients co-infected with HIV. However, the natural history of HCV infection in both mono-infected and co-infected patients remains highly variable. The patterns and predictors of fibrosis progression in the HIV/HCV co-infected population are not fully characterized. Given the invasiveness of serial liver biopsies, Fibrosis-4 score (FIB-4), a composite of non-invasive biomarkers that correlate with fibrosis stage, is increasingly used. We used FIB-4 to study the natural history of liver disease progression in a cohort of co-infected patients and evaluated predictors of progression to cirrhosis over 5 years prior to treatment with direct acting agents (DAAs).

Methods: All HIV/HCV co-infected patients receiving care at Yale-New Haven Hospital from February 2014 through April 2016 with a minimum of 3 annual FIB-4 scores were included in the study. Annual FIB-4 scores dating back 5 years were calculated from the most recent FIB-4 score or the last FIB-4 prior to DAA treatment initiation. FIB-4<1.45 indicated absence of cirrhosis and FIB-4>3.25 indicated cirrhosis. Baseline demographics and clinical characteristics such as HCV genotype, HIV viral load and CD4 counts were collected. Patients were further categorized based on FIB-4 progression over the course of 5 years.

Results: The sample of 83 men and 43 women had a mean age of 56.9 years; 31.7% were white, 54.0% were black. Injection drug use (IDU) was the major risk factor for HCV acquisition (77.0%) and the most common genotype was genotype 1 (83.8%). 71 patients (60.2%) had CD4 count >500 cells/mm3, and the majority (90.0%) had HIV viral loads 3.25, 67 (53.2%) had FIB-4 remain <3.25, and 29 (23.0%) had FIB-4 remain >3.25. For patients who progressed to >3.25, median FIB-4 progressed from 2.59 to 4.13, while for patients who remained <3.25, median FIB-4 remained relatively stable but progressed from 1.56 to 1.65 over 5 years.

Conclusion: Progression to cirrhosis over 5 years in co-infected individuals occurred in only a minority of patients and those who progressed to cirrhosis started out with a higher FIB-4 than the non-progressors. Further research will elucidate the predictors of FIB-4 progression and enable the prioritization of patients for whom treatment is more critical.

Bianca Yuh, BS1, Onyema Ogbuagu, MD, FACP2 and Merceditas Villanueva, MD1, (1)Yale University School of Medicine, New Haven, CT, (2)Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT


B. Yuh, None

O. Ogbuagu, None

M. Villanueva, None

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