CHROMY David

Previous University and Subject: Medical University of Vienna/Medicine

Thesis since: 11/2017

Hepatitis C as a Remaining Challenge in Patients Infected with HIV

Hepatitis C as a Remaining Challenge in Patients Infected with HIV

Due to shared routes of transmission people infected with the human immunodeficiency virus (HIV) are also at increasing risk for coinfection with hepatitis C virus (HCV), a common cause for chronic liver disease, which is considered as major contributor to morbidity and mortality in individuals infected with HIV. Since the establishment of modern antiretroviral therapy (ART) to effectively suppress HIV, acquired immunodeficiency syndrome (AIDS)-related mortality is on the decline while the prevalence of HIV  infections is increasing. Thus, chronic illnesses gain on importance in this aging population.

Historically, HIV+ individuals chronically infected with HCV (CHC) were considered as difficult to treat, since the only curative therapy for CHC was interferon (IFN)-based. A poorly tolerated treatment with moderate efficacy among HCVmonoinfected and even worse performance in HIV/HCV-coinfected individuals. However, recently introduced IFN-free direct-acting antiviral (DAA)-based treatment regimens have been shown to have excellent tolerability, short treatment durations and very high efficacy, irrespective of the HIV status. Thus, the major challenge in the management of HIV/HCV-coinfected patients recently shifted from supervising a long and troublesome therapy to identify HIV/HCV-coinfected patients in order to initiate treatment without delay and to prevent novel- or re-infection with HCV.

Aims:
In this doctoral thesis, I will characterize a cohort of HIV-infected patients with either ongoing HCV-coinfection or sustained virologic response (SVR) following spontaneous- or treatment induced clearance. Patients will be identified using the data documented in the patient management system at the medical university of Vienna (MUW). All HIV infected individuals with prior exposure to HCV, determined by HCV-antibody seroconversion, and at least one visit at our HIV and liver disease outpatient clinic will be included in this retrospective study.

I will extensively characterize patients with regard to epidemiologic-, liver disease-, HCV infection-, HIV infection- and treatment- specific characteristics. I will assess outcome data of all patients who underwent HCV therapy and collect above mentioned features at follow-up. Thus, I will be able to derive information on efficacy and safety of IFN-free DAA regimens in HIV+ patients with acute hepatitis C (AHC) infection. Furthermore, characteristics of all HIV/HCV-coinfected individuals before and after IFN-free DAA-based treatment as well as prevalence and progression of steatosis, defined by controlled attenuation parameter (CAP), throughout therapy will Thesis proposal for the Doctoral Program N790 Clinical Endocrinology, Metabolism and Nutrition 3 be investigated. The acquired data should also enable me to outline the incidence and the supposedly ongoing epidemic of AHC among HIV+ men who have sex with men (MSM) in a Central European tertiary center. Finally, I will assess the major hindering factors for HIV/HCV-coinfected patients to present at our outpatient clinic for treatment initiation and discuss strategies to handle patients with poor compliance.

Methods and Skills:

Clinical studies; Fibroscan

Publications:

Chromy D, Schwabl P, Bucsics T, Scheiner B, Strassl R, Mayer F, Aichelburg MC, Grabmeier-Pfistershammer K, Trauner M, Peck-Radosavljevic M, Reiberger T, Mandorfer M. Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients. Wien Klin Wochenschr 130: 105-114, 2018 

Schwabl P, Mandorfer M, Steiner S, Scheiner B, Chromy D, Herac M, Bucsics T, Hayden H, Grabmeier-Pfistershammer K, Ferlitsch A, Oberhuber G, Trauner M, Peck-Radosavljevic M, Reiberger T. Interferon-free regimens improve portal hypertension and histological necroinflammation in HIV/HCV patients with advanced liver disease. Aliment Pharmacol Ther 45: 139-149, 2017

Mandorfer M, Kozbial K, Schwabl P, Freissmuth C, Schwarzer R, Stern R, Chromy D, Stättermayer AF, Reiberger T, Beinhardt S, Sieghart W, Trauner M, Hofer H, Ferlitsch A, Ferenci P, Peck-Radosavljevic M. Sustained virologic response to interferon-free therapies ameliorates HCV-induced portal hypertension. J Hepatol 65: 692-699, 2016

Chromy D, Mandorfer M, Bucsics T, Schwabl P, Bauer D, Scheiner B, Schmidbauer C, Lang GF, Szekeres T, Ferenci P, Trauner M, Reiberger T. Prevalence and predictors of hepatic steatosis in patients with HIV/HCV coinfection and the impact of HCV eradication. AIDS Patient Care STDS 33: 197-206, 2019