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Treat HCV Early or you are at risk of cirrhosis & then not achieving regression of fibrosis which increases death rate & liver-related complications.....study finds fibrosis regression is required even with an SVR to reduce all-cause death & liver-related death.....THUS, early HCV treatment is crucial, waiting until cirrhosis is tantamount to a 50% chance of a death sentence
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Jules Levin, NATAP
IAS: Frequent Fibrosis Regression With SVR in HCV/HIV+, Cutting Death Risk - (07/28/15)
Watch Oral Presentation on YouTube:
https://www.youtube.com/watch?v=pnHtjW_zFtA&feature=youtu.be
IAS 2015: 8th IAS Conference on HIV Pathogenesis Treatment and Prevention
Vancouver Canada 18-22 July 2015
all the patients in this study appeared to have at least relatively advanced disease at baseline and had HCV for over 20 years, with relatively low Cd4 counts. Patients with less advanced HCV disease were more likely to achieve SVR & of course patients with an SVR were more likely to achieve fibrosis regression
Patients with more advanced liver disease were less likely to achieve SVR
45% of patients with an SVR did not achieve fibrosis regression
55% of patients with SVR achieved fibrosis regression while only 15% without SVR achieved fibrosis regression
delaying HCV therapy decreases chance for fibrosis regression & early HCV treatment increases chance for regression
Of note, see 2nd slide below - an SVR without fibrosis regression reduces death risk compared to no SVR & no regression BUT death rates is worse than when compared to SVR with regression. The point - TREAT EARLY.......once a patient has advanced liver disease they face increased risk for disease & death because they were less likely to achieve fibrosis regression. Even patients who achieve fibrosis regression risk liver disease but in this study those rates were low but a few patients who achieved SVR & FR still died or had liver complications.
AUTHOR CONCLUSIONS:
1- "Our study clarifies the risk of complications after therapy in HIV-infected patients with cirrhosis, showing a lower rate if fibrosis regression is attained in addition to SVR."
2- "Moreover, we demonstrate that the histological benefit is clearly associated with the lowest risk of any-cause death, liver-related death, and hospital admissions"
3- "Cumulative evidence demonstrates that SVR is associated with a lower rate of death and liver related complications1,2. However, in spite of a lower risk, patients with cirrhosis are not entirely protected against the development of liver complications or HCC after SVR3,4."
4- "Of clinical application, LSM is useful in demarcating cirrhotic patients at a high risk for complications after therapy, and who would require a more frequent check-up. Sequential LSM after therapy could be useful in the management of the patients, irrespective of achieving SVR."
You can see the vast difference in death rates between those with an SVR & who also achieved fibrosis regression vs those with an SVR who did not achieve fibrosis regression in this slide immediately below.....
THE ONLY VARIABLE ASSOCIATED WITH ALL-CAUSE DEATH & Liver-Related DEATH in regression analysis was FIBROSIS REGRESSION.....although SVR is associated with reduced liver-related complications....THUS, early HCV treatment is crucial, waiting until cirrhosis is tantamount to a 50% chance of a death sentence
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