Liver Function Following Hepatitis C Virus Eradication by Direct Acting Antivirals in Patients With Liver Cirrhosis: Data from The PITER Cohort

Background: The development of direct-acting antivirals (DAA) for HCV has revolutionized the treatment of HCV, including its treatment in patients with HIV coinfection. The aim of this study was to compare the changes in liver function between coinfected and monoinfected patients with cirrhosis who achieved HCV eradication by DAA in the multicenter PITER cohort. Methods: Patients with pre-treatment diagnosis of HCV liver cirrhosis, consecutively enrolled in PITER, who achieved a sustained virological response (SVR12) and with an available follow-up after DAA treatment, were analysed. Liver function was prospectively evaluated as changes in Child-Pugh (C-P) class during patient’s follow-up after the end of DAA treatment. Cox regression analysis was used to evaluate factors independently associated with changes in liver function following viral eradication. Results: We evaluated 1350 successfully DAA treated patients with cirrhosis, of whom 1242 HCV monoinfected (median follow-up of 24.7, range 6.8-47.5 months after viral eradication) and 108 (8%) HCV/HIV coinfected (median follow-up of 27.1, range 6-44.6 months after viral eradication). Despite the significant younger age (p<0.001), coinfected patients had higher liver disease severity in terms of C-P class score (p<0.001). Following HCV eradication, C-P class improved in 17/20 coinfected (85%) and in 53/82 (64.6%) monoinfected patients with a pre-treatment C-P class B or C (p>0.05). C-P class worsened in 3/56 coinfected (5.3%) and in 84/1024 (8.2%) monoinfected patients with pre-treatment C-P class A or B (p>0.05). Factors independently associated with C-P class deterioration were male sex (HR=2.01; 95% CI=1.19-3.40), platelet count <100,000/µl (HR=1.88; 95% CI 1.17-3.03) and higher pretreatment INR value (HR=2.34; 95% CI 1.47-3.71). Following viral eradication, in 7 of 15 coinfected (47%) and in 61 of 133 (45.6%) monoinfected patients with previous history of decompensation a new decompensating event occurred. An incident decompensating event was recorded in 4 of 93 (4.3%) coinfected and in 53 of 1109 (4.8%) monoinfected patients. Conclusions: Improvement of liver function is observed following HCV eradication in the majority of patients with cirrhosis; however viral eradication does not always mean cure of liver disease in both monoinfected and coinfected patients with advanced liver disease.