international workshop on co-infection hiv & hepatitis - virology...
TRANSCRIPT
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13th International workshop on co-infection
HIV & Hepatitis
23 June 2017
Lisbon - Portugal
Authors: Sarmento – Castro R., Marques M., Tavares A., Gonçalves C, Furtado I.,
R. de Valdoleiros S., Vasconcelos O., Seabra J., Méndez J.
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New direct antiviral agents (DAAs) are safe and effective in the treatment of
patients with hepatitis C infection.
Few clinical trials included a significant number of cirrhotic co-infected
patients.
In this study, we evaluate the efficacy and safety of DAAs in the treatment of
cirrhotic HCV/HIV co-infected patients in a real life setting.
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Prospective study of cirrhotic (TE ≥ 12.5 kPa) HCV/HIV
co-infected patients under HAART
113 patients initiated treatment with DAAs for
12 or 24 weeks
We compared the baseline and SVR12 characteristics
Possible factors associated with SVR12 were
analysed
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93,8%
3,5% 2,7% Risk factor
IDU
Sexual
Unknown
Characteristics Value
Mean age 47 years old
Male sex 98 (86.7%)
HIV infection Mean
CD4+/mm3
count
577
Viral load
< 20 cp/ml
107
(95%)
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Characteristics Value
Treatment experienced
38 (33.6%)
Transient elastrography (TE)
12.5 -25 kPa
≥ 25 kPa
70 (61,9%)
43 (38.1%)
Endoscopic signs of portal hipertension 22 (19.5%)
MELD mean score 8,7
Child pugh score A 112 (99.1%)
Platelets/µL
< 75 x 103
≥ 75 x 103
19 (16.8%)
94 (83.2%)
Albumin (g/dl)
< 3.5
≥3.5
10 (8.9%)
103 (91.1%)
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77%
0,90%
12,40%
9,70%
G1 G2 G3 G4
Mean HCV RNA –
3.835.653 UI/ml
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SOF/LDV
SOF/LDV + RBV
SOF + RBV
PEG IFN + RBV+ SOF
SOF/DCV + RBV
3 D´S
SOF+ DCV
50,4%
34,0%
5,3%
3,5%
2,7%
2,7%
1,8%
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Without statistically significant differences
[VALOR]%
[VALOR]%
[VALOR]%
[VALOR]%
G1 G2 G3 G4
[VALOR]%
[VALOR]%
Naive Treatmentexperienced
[VALO
R]%
Global
106
113 71
75
35
38
83
87
1
1 12
14
10
11
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Albumin
(g/dl)
SVR 12 (% and N)
No Yes
< 3,5 3,6% (4) 5,4% (6)
≥ 3,5 2,7% (3) 88,5% (100)
Total 7 106
Albumin < 3,5 g/dl was
associated with poor SVR12
(p=0.007)
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4,32 4,33
4,41
4,45
4,5
Baseline W4 EOT PT4W SVR12
Statiscally significant improvement (p < 0.05)
129.000
145.000
153.214
143950 142405
Baseline W4 EOT PT4W SVR12
Albumin Platelets MELD score
baseline: 8,7
PTW12: 6,2
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25,8
21,8 19,1
Baseline EOT SVR12
Statiscally
significant decrease
(p < 0.05)
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Five patients decompensated
- Two with encephalopaty
- Two developed hepatocellular carcinoma
- One had variceal bleeding
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Patient Genotype IL 28B
Baseline Previous
HCV
treatment
DAAs
combination Outcome
Albumin
(mg/dl)
Child-
Pugh
Score
MELD
score
HCV RNA
(UI/mL)
TE
(KPa)
Platelets
(x103/ ul)
1 1 Unkno
wn 5,14 A
8 4.970.000 26,6
155 Yes
SOF/LDV //
24w Relapse
2 1 Unkno
wn 4,5 A
7
2.400.000 17,6
162
No SOF/LDV //
24w
Lost to
follow up
3 4 Unkno
wn 2,34 A
12
7.190.000 51,4
141
Yes SOF/LDV+RBV
// 24w
Lost to
follow up
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Patient Genotype IL
28B
Baseline
Previous
HCV
treatment
DAAs
combination Outcome
Albumin
(mg/dl)
Child-
Pugh
Score
MELD
score HCV RNA
(UI/mL)
TE
(KPa)
Platelets
(x103/ ul)
4 1 CC 3,6 B
11 22500 49,7
119 Yes
SOF/LDV+RBV
// 24w
Died
(encephal
opathy)
5 1 CT 3,5 A 7
6.100.000 15,3 227 No SOF/LDV+RBV
// 12w
Died
(AMI)
6 3 CC 3,30 A 10
1.370.000 36 102 No SOF/LDV + RBV
// 24w
Died
(HCC)
7 3 CT 3,37 A
11 153.000 47,2 61 No SOF/DCV // 24w
Died
(Acute GI
bleeding)
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SVR was achived in 93.8% of HCV/HIV cirrhotic patients.
Liver function had a significant improvement during the
treatment with DAAs (MELD score, liver fibrosis, platelets
and albumin).
Lower level of albumin was significantly associated with
poor SVR 12.
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Rui Sarmento e Castro
Josefina Méndez
Ana Horta
Ana Paula Tavares
João Seabra
Olga Vasconcelos
Miguel Araújo
Maria João Gonçalves
Celina Gonçalves
Isabel Furtado
Cristina Soeiro
Maria José Santos
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13th International workshop on co-infection
HIV & Hepatitis
23 June 2017
Lisbon - Portugal