Background:  Chronic hepatitis C virus (HCV) leads to progressive liver fibrosis, which is accelerated in HCV/HIV-co-infected patients. Therapy with interferon (IFN) ± ribavirin (RBV) for 6 to 12 months allows reaching sustained virological response (SVR) in fewer than half of co-infected patients. An improvement in liver fibrosis should be expected in the subset of patients attaining SVR. However, this benefit has not been proven in HCV/HIV-co-infected patients.

Methods:  All HIV/HCV-co-infected patients who had completed a full course of HCV therapy with IFN (or pegylated IFN) ± RBV in the past at our institution and were seen during the last 12 months were identified. All had elevated liver enzymes before receiving HCV therapy and some extent of hepatic fibrosis (F1-F4) in the liver biopsy. Current liver fibrosis was measured in all using elastometry by FibroScan.

Results:  A total of 112 HIV/HCV-co-infected patients were analysed (76% males, mean age 36±7 years, 67% on HAART). HCV genotype distribution was:  1 (70%), 3 (24%), and 4 (6%). A total of 44 had SVR while the remaining 68 were non-responders or relapsers. The main demographic features were comparable between both groups. Information for other variables is recorded in the table. F3-F4 estimates were less frequent in SVR than in non-SVR (OR 2.6; p = 0.04). Interestingly, in patients with SVR the mean lag between the end of HCV therapy and elastometry assessment was longer in patients showing F0-F1 as compared with those with F2-F4 (38 vs 22 months; p = 0.06). Moreover, all 3 patients cured ≥10 years earlier were F0-F1.

Conclusions:  SVR after IFN-based therapies may lead to regression of HCV-related liver fibrosis in HIV-co-infected patients. However, long periods of time seem to be required to show this benefit.