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Table 3 Liver fibrosis progression, decompensation and end stage liver disease outcomes

From: Antiretroviral therapy and liver disease progression in HIV and hepatitis C co-infected patients: a systematic review and meta-analysis

Study Intervention Outcome Follow-up duration Effect estimate Statistically significant?a Adjustments
End-stage liver disease (ESLD) and decompensation events
 Giron-Gonzalez (2007) [29] cART Decompensationj Median 20 months (IQR 12 to 28) HR 0.376 (95 % CI 0.161 to 0.883) Yes. Favours treatment Liver disease severity
 Giron-Gonzalez (2007) [29] cART Decompensationj Median 20 months (IQR 12 to 28) NR No None
 Pineda (2009) [32] cART Decompensation Mean 36 months (SD 27), range 1 to 131 months RR 1.06 (95 % CI 0.30 to 3.71) No None
 Ragni (2009) [27] cART & ARV monotherapy ESLD NR (up to 35 years from HCV infection) RR 1.00 (95 % CI 0.37 to 2.71) No None
 Ragni (2009) [27] cART vs. ARV monotherapy & no ARVb Time to ESLD NR (up to 35 years from HCV infection) HR 3.14 (95 % CI 1.27 to 7.08) (30.3 vs. 20.0 Years) Yes. Favours treatment Multivariate (covariates NR)
Liver fibrosis progression (dichotomous)
 Macias (2006) [25] cART with PI Liver fibrosis progressiond Median 1.6 to 7 years OR 0.4 (95 % CI 0.2 to 0.7) Yes. Favours treatment Age at infection, CD4 count
 Macias (2006) [25] cART with PI switched to efavirenz Liver fibrosis progressiond Median 1.6 to 7 years OR 0.3 (95 % CI 0.1 to 0.7) Yes. Favours treatment Age at infection, CD4 count
 Schiavini (2006) [28] cART and ARV monotherapy Liver fibrosis progressione Median 54 months (IQR 50 to 86) OR 2.5 (95 % CI 0.64 to 9.65) No None
 Macias (2009) [24] cART and ARV monotherapy Liver fibrosis progressionh 3 years OR 0.94 (95 % CI 0.67 to 1.33) No Multivariatek
 Mehta (2005) [30] ARV monotherapy Advanced fibrosis or cirrhosisc Median 5 years (IQR 2.9 to 7.5) OR 0.61 (95 % CI 0.18 to 2) No None
 Mehta (2005) [30] cART Advanced fibrosis or cirrhosisc Median 5 years (IQR 2.9 to 7.5) OR 0.92 (95 % CI 0.48 to 1.8) No None
 Sanmartin (2014) [33] cART Liver fibrosis progressioni Median 7.8 years (IQR 5.5 to 10.0) HR 1.94 (95 % CI 0.46 to 8.13) No None
Liver fibrosis progression (continuous)
 Macias (2006) [25] cART with: NVP; or efavirenz; or with PI switched to NVP Fibrosis progression ratef Median 1.6 to 7 years Median rate 0.087 to 0.115 No None
 Macias (2006) [25] cART with zidovudine/lamivudine, or with stavudine/lamivudine Fibrosis progression ratef Median 1.6 to 7 years Median rate 0.107 and 0.112 Yes. Favours treatment None
 Mariné-Barjoan (2004) [35] cART Fibrosis progression ratef Median 19 to 20 years MD −0.06 (95 % CI −0.14 to 0.01) No None
 Reiberger (2010) [36] cART Fibrosis progression ratef NR MD 0.01 (95 % CI −0.01 to 0.04) No None
 Reiberger (2010) [36] cART Time to cirrhosisg from initial HCV exposure NR MD −1.00 (95 % CI −7.26 to 5.26) No None
  1. cART combination antiretroviral therapy, PI protease inhibitors, NVP nevirapine
  2. a p < 0.05
  3. bARV monotherapy patients formed 62 % of the comparator group in this analysis
  4. cIshak score ≥ F3 measured with liver biopsy
  5. dOdds of slower fibrosis proression (fibrosis progression rate ≥0.2 vs <0.2), fibrosis measured with liver biopsy
  6. e≥1 Knodell-Ishak stage increase between two liver biopsies
  7. fMETAVIR Fibrosis stage (0 to 3) measured by liver biopsy/length of HCV infection
  8. gIn years, measured with liver biopsy
  9. h≥1 Scheuer stage increase between two liver biopsies spaced by ≥1 year
  10. iLiver stiffness value ≥9.5 kPa or died of liver disease
  11. jSubgroup without previous decompensation at baseline
  12. kAge, undetectable HIV viraemia, genotype 3, ALT and necroinflammatory activity at baseline, time between liver biopsies, HCV treatment response