Interferon-free regimens improve portal hypertension and histological necroinflammation in HIV/HCV patients with advanced liver disease

Background HIV/HCV co-infected patients show accelerated fibrosis progression and higher risk for complications of portal hypertension (PHT). Aim To assess the effects of interferon-free therapy on portal pressure, liver histology and plasma biomarkers in HIV/HCV-coinfected patients with PHT. Methods Twenty-two patients with paired hepatic venous pressure gradient (HVPG) measurements prior and after successful treatment (SVR) with interferon-free regimens were included. Liver stiffness was assessed by transient elastography and biopsies were scored according to METAVIR. Plasma biomarkers were determined by ELISA. Results Overall, HVPG decreased from 10.7 +/- 4.1 mmHg at baseline to 7.4 +/- 4.2 mmHg after HCV treatment (Delta:-3.3 +/- 2.7 mmHg; p < 0.001). In patients with clinically significant PHT (HVPG >= 10 mmHg, n = 11), HVPG decreased from 14.1 +/- 2.9 to 10.4 +/- 3.9 mmHg (Delta:-3.7 +/- 3.3 mmHg; p = 0.004) and a haemodynamic response (HVPG decrease >= 10%) was observed in 73%. In 64% of patients with subclinical PHT (HVPG 6-9 mmHg, n = 11), portal pressure normalised at SVR. Mean liver stiffness decreased from 20.8 kPa to 11.5 kPa (Delta:-8.8 +/- 7.4 kPa; p < 0.001). Fifty percent (7/14) of patients with cirrhosis were re-classified as METAVIR <= F3 and all patients with decompensated cirrhosis improved their Child-Pugh stage. After successful HCV treatment, 39% still had persistent histological necroinflammatory activity (METAVIR A1), which correlated with less HVPG response and more steatosis. While most biomarkers improved with SVR, METAVIR A1 patients had significantly higher plasma levels of fibrogenic (PDGF, TGF-beta) and angiogenic (VEGF, Angiopoietin1) biomarkers. Conclusions Interferon-free therapy reduces PHT and halts histological necroinflammatory activity in the majority of HIV/HCV-coinfected patients after SVR, which may lead to re-compensation of liver function in cirrhosis. Biomarkers could identify patients with persisting hepatic necroinflammation.