The Effect of Unsuccessful Treatment with Peginterferon and Ribavirin on the Liver Fibrosis Course of HIV/HCV-Coinfected Patients

Background: The course over time of different fibrosis parameters in HIV/HCV-coinfected patients who did not suppress HCV during anti-HCV therapy, and in patients who suppressed HCV but relapsed after treatment discontinuation is unclear. Methods: A total of 248 patients were included in the study (81 non-responders, 49 relapsers, and 118 control, untreated patients). Four primary non-invasive fibrosis indices (transient elastometry, APRI, Forns, and FIB4), as well as other fibrosis parameters, were evaluated in each group at baseline, at the end of anti-HCV therapy and at the end of follow-up (median 39.35 months from baseline). Results: Groups were comparable in baseline characteristics, except for lower fibrosis indices in the control group. In this group there was a consistent increase in all fibrosis indices over time. On the contrary, treated patients experienced certain improvements in these indices during the period of treatment and a further worsening when the treatment was stopped, to reach the pretreatment values at the end of follow-up. Relapsers had also more favorable course than non-responders in each fibrosis parameter, but the differences were small and not statistically significant. Conclusions: HIV/HCV-coinfected patients who undergo unsuccessful anti-HCV treatment experience some improvement in liver fibrosis as compared to untreated patients, although the differences are small. Relapsers have also a more favorable fibrosis course than non-responders, but the differences are minimal. These improvements are only limited to the treatment period. Therefore the effect of unsuccessful treatment would only represent a transitory delay in fibrosis progression.