CROI 2022: Summary of 14 key studies on HIV and liver disease
Unfortunately, 2022 has now become the third year in row where CROI had to take place as a virtual conference meeting.
This however, has not strongly impacted interest or participation in the CROI meeting but has been accompanied by a significantly lower number of abstract submissions in the liver disease field. As a consequence of shifted interests but also rechanneled research money and working capacity, new results around COVID-19 vaccines and antivirals have dominated the scientific submissions to CROI with many subsequent oral abstract sessions covering various new aspects of COVID-19 research.
The oral abstract session for hepatitis research was integrated into the session on tuberculosis, opportunistic infections, and hepatitis. Indeed, there was only one oral abstract on translational HBV research, two on HCV, one on talaromycosis and five on various aspects around tuberculosis in that particular session. Nevertheless, there were still numerous interesting abstract submissions which could be found in the poster sessions focusing on various aspects of liver disease in HIV.
The main topic in the oral abstract session was HCV elimination targets in light of the COVID-19 pandemic but also availability of easy to administer all oral HCV direct-acting antiviral (DAA)-based therapies. [1, 2]
Whereas, the US appears to struggle even more under the impact of COVID-19 on hepatitis services to stay on target for reaching the HCV elimination goals, Western Europe and Australia are well on track in their HIV/HCV coinfected population to reach HCV elimination by 2030.
Another important HCV presentation highlighted the advantages of universal HCV screening among pregnant people attending care in Western Pennsylvania versus risk-based HCV screening. 
Other important topics discussed at this year CROI included results of a randomized HBV vaccination trial, new HBV infections in an HIV cohort in Texas, new long-acting tenofovir formulation for HBV therapy, HCV elimination in MSM, DAA salvage therapy, clinical outcomes after SVR and various aspects around fatty liver disease. [4-14]
The following summary aims at highlighting some of the exciting new data reported at CROI 2022 and to initiate a discussion about their usefulness and relevance for clinical management of liver disease in HIV-coinfected individuals.
- HBV revaccination with three double doses of HBV vaccine achieves higher serological responses than with three standard-doses of HBV vaccine among MSM who were born in the era of universal neonatal HBV vaccination. Reassuringly, virologically suppressed people living with HIV with CD4 counts >500 cells/mm3 show similar responses after revaccination as HIV negative MSM.
- People living with HIV who are unvaccinated for hepatitis B are at higher risk for new hepatitis B infections. A particular high risk was found among those individuals with hepatitis C. In conclusion, this study strongly recommends HBV vaccination in HBV seronegative people living with HIV even if they are on dual active HIV/HBV antiviral therapy.
- A nanoformulated TFV prodrug suppresses HBV DNA in humanised and transgenic mice for three months. These data suggest that a long-acting tenofovir formulation for treatment of HBV infection can be developed.
- The US is currently not on track to achieve the WHO elimination targets pre-pandemic and has fallen further behind during the COVID-19 pandemic. Increased efforts including scale-up of HCV diagnosis, treatment, and prevention are needed to overcome this unfavorable development.
- Pooled analysis from Australia and selected Western European countries demonstrates that following broad access to DAA therapy these countries are on track to meet the WHO elimination incidence target for people living with HIV in care by 2030.
- The German NoCo cohort demonstrates stable HCV incidence rates despite a broad use of DAAs up to 2019. In 2021, however, micro-elimination goals are met due to a drop in HCV incidence, possibly due to behavior changes related to the SARS-CoV-2 pandemic and associated containment measures or because of a declining HCV reservoir over time with many MSM successfully treated with DAAs. These results emphasise that HCV elimination in MSM is achievable.
- With regular HCV testing and improved access to antiviral treatments, particularly highly effective direct-acting antivirals (DAAs) in Taiwan, the incidence rate and prevalence of HCV viremia have declined by 80% among people living with HIV between 2011 and 2021.
- Risk-based HCV screening is insensitive for HCV detection within the general obstetric population. In contrast universal HCV screening of pregnant people does not only ensure that the pregnant person is linked to treatment, but also enables detection of all cases of perinatal HCV transmission.
- SOF/VEL/VOX is highly effective for HCV treatment in people living with HIV previously failing to DAA regimens. Effectiveness was confirmed across all genotypes and in the presence of cirrhosis.
- Ravidasvir + sofosbuvir was well tolerated with excellent safety and efficacy in chronic HCV infection, including in difficult-to-treat populations (GT3, cirrhosis, prior HCV treatment, HIV co-infection).
- The risk of clinical progression to liver disease associated events following DAA-induced SVR in people with HIV/HCV coinfection with advanced fibrosis is independently associated with age, sex, liver disease severity, and changes in liver stiffness one year after finalization of HCV therapy.
- Within the MACS Coronary Atherosclerosis Progression Study the incidence rate of CT-measured NAFLD was high at 2.5/100 PYs. Higher BMI and visceral adiposity, but not HIV, were associated with incident NAFLD.
- A high prevalence of liver steatosis can be found among people living with HIV on ART in Switzerland. In addition to well-established risk factors such as age, ethnicity and obesity, the use of TAF was significantly associated with hepatic steatosis.
- Among people living with HIV without concomitant causes of liver disease other than NAFLD, liver stiffness as well as FAST score predict overall survival.
- Cannabis use may reduce the risk of hepatic steatosis in HIV/HCV-negative and those with HIV monoinfection, but not in HCV-positive individuals. Further studies are needed to help better understand the biological mechanisms for the beneficial effect of cannabis use observed in this study.
This article only includes the introduction, summary points and references from a longer detailed report of these studies. For the full article, please see NATAP.org.
Rockstroh JK. Summary from virtual CROI 2022 for HIV and liver disease Hepatitis elimination for 2030 on track? Is fatty liver disease a growing concern? New insights from CROI 2022.
These references are for the full online report at natap.org.
- Ortega REF et al. Modelling impact of COVID-19 pandemic on hepatitis C virus elimination in the US. CROI 2022, 12–16 February 2022, virtual. Oralabstract 72.
- Van Santen DK et al. Effect of direct-acting antivirals on HCV incidence among people living with HIV. CROI 2022, 12–16 February 2022, virtual. Oral abstract 73.
- Chappell C et al. Universal hepatits C virus screening in pregnancy: the juice is worth the squeeze. CROI 2022, 12–16 February 2022, virtual. Oral abstract 27.
- Huang C et al. Randomized Trial of HBV Revaccination in MSM Born in the Neonatal Vaccination Era. CROI 2022, 12–16 February 2022, virtual. Poster abstract 544.
- Jain MK et al. New Hepatitis B infection among HIV patients: Who is at risk? CROI 2022, 12–16 February 2022, virtual. Poster abstract 548.
- Das S et al. A nanoformulated TFV prodrug suppresses HBV DNA in humanized and transgenic mice for three months. CROI 2022, 12–16 February 2022, virtual. Poster abstract 545.
- Ingiliz P et al. The impact of COVID-19 on HCV microelimination in MSM in Germany. CROI 2022, 12–16 February 2022, virtual. Poster abstract 539.
- Ho SY et al. Progress towards HCV microelimination among HIV-positive patients in Taiwan. CROI 2022, 12–16 February 2022, virtual. Poster abstract 538.
- Carbonero LM et al. Treatment with SOF/VEL/VOX in HIV-HCV coinfected patients previously exposed to DAAs. CROI 2022, 12–16 February 2022, virtual. Poster abstract 529.
- Berenguer J et al. Impact of SVR with DAAs in coinfected patients with advanced fibrosis/cirrhosis. CROI 2022, 12–16 February 2022, virtual. Posterabstract 531.
- Price J et al. High incidence of CT-measured NAFLD in men with and without HIV infection. CROI 2022, 12–16 February 2022, virtual. Poster abstract 523.
- Riebensahm C et al. Determinants of liver steatosis in people living with HIV on antiretroviral therapy. CROI 2022, 12–16 February 2022, virtual. Poster abstract 524.
- Macias J et al. Impact of NASH on the survival of people living with HIV. CROI 2022, 12–16 February 2022, virtual. Poster abstract 518.
- Diaz-Martinez J et al. Cannabis use and hepatic steatosis by MRI-PDFF. CROI 2022, 12–16 February 2022, virtual. Poster abstract 525.
- Jain MK et al. Low rates of hepatitis B vaccination among people with HIV. CROI 2022, 12–16 February 2022, virtual. Poster abstract 546.
- Heuft MM, et al. Protective effect of hepatitis B virus-active antiretroviral therapy against primary hepatitis B virus infection. AIDS. 2014;28:999-1005.
- Kusejko K et al. A systematic re-screening for hepatitis C RNA among men who have sex with men living with HIV in the Swiss HIV Cohort Study two years following a nation-wide elimination program reveals a sustainable effect towards hepatitis C elimination. EACS 2021; OS2/3.
- Tan SS et al. Efficacy & safety of ravidasvir + sofosbuvir in hepatitis C: STORM-C-1 final results. 29th Virtual Conference on Retroviruses and Opportunistic Infections, February 12-16, 2022, abstract 528.
- Bischoff J et al. Stratifying the risk of NAFLD in patients with HIV under combination antiretroviral therapy (cART). EClinicalMedicine. 2021 Sep 5;40:101116.
- Eslam M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol 2020; 73(1):202-209.