Examination of Fiscal Management and the Allocation of Care Act Resources US Department of Health and Human Services: Health REsources and Services Administration
INTRODUCTION
HIV/HCV Coinfection
HCV Treatment
Response to HCV Treatment: Prognostic Factors
Liver Biopsy
Treatment Strategies
Side Effects and Strategies for Managing Them
The Week 12 Early-Stopping Rule
Treating HCV: Long-Term Benefits
Treatment of Acute HCV
Expanding Access to Treatment
Barriers and Key Issues
Conclusion
Resources
References

Liver Biopsy

Liver biopsy is the diagnostic gold standard for assessment of liver damage and its causes. However, experts are debating the requirement for a pre-treatment biopsy because of the rare but serious risks associated with biopsy (puncture of adjoining organs, hemorrhage and—very rarely—death),112-114 the possibility of sampling error,115,116 and patient reluctance. A liver biopsy is most useful for detecting mild to moderate liver damage, because more severe liver damage, cirrhosis, can be identified with clinical, laboratory, and radiographic testing. Requiring liver biopsy as a prerequisite for HCV treatment may create a barrier for some patients.

HCV and Liver Transplantation
Liver transplantation may be the only option for coinfected patients with advanced liver disease. HCV treatment may cause hepatic decompensation in some cirrhotic patients,117 but access to transplantation for PLWHA is limited by policies of individual transplant centers. Despite promising rates of posttransplantation survival, some centers do not perform transplants in PLWHA, and the persistent shortage of donor organs and reluctance of third-party payers to reimburse contribute to the difficulty as well, despite promising data on posttransplantation survival of HIV-positive patients, which is similar to that of HIV-negative patients.119-121 Clinicians and their coinfected patients have another option: A trial sponsored by the National Institute of Allergy and Infectious Diseases on kidney and liver transplantation in people with HIV. For more information on study sites and eligibility, go to: http://spitfire.emmes.com/study/htr/.

Although researchers are working to create a less invasive replacement for liver biopsy that uses panels of blood tests and imaging techniques, nothing has been validated for use in coinfected people. Given the limited efficacy and substantial side effects of HCV treatment, some providers feel that a biopsy is necessary to identify patients who can defer treatment. Others recommend biopsy for patients with genotype 1 and a high viral load because they are less likely to respond to treatment; biopsy may not be required for patients with genotype 2 or 3 because the likelihood that they will achieve an SVR is significantly greater.30,44,117

 

 
 
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