Enhanced liver fibrosis marker as a noninvasive predictor of mortality in HIV/hepatitis C virus-coinfected women from a multicenter study of women with or at risk for HIV. (13th March 2016)

• Record Type: Journal Article
• Authors: Peters, Marion G.; Bacchetti, Peter; Boylan, Ross; French, Audrey L.; Tien, Phyllis C.; Plankey, Michael W.; Glesby, Marshall J.; Augenbraun, Michael; Golub, Elizabeth T.; Karim, Roksana; Parkes, Julie; Rosenberg, William
• Is Part Of: AIDS. Volume 30:Number 5(2016)
• Publication Date: 2016-03-13
• Subjects: hyaluronic acid -- liver fibrosis -- noninvasive markers -- procollagen III aminoterminal peptide -- tissue inhibitor of matrix metalloproteinase; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000975
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: Coinfection with hepatitis C virus (HCV) is a major cause of morbidity and mortality among individuals with HIV. Our objective was to assess the prognostic performance of noninvasive measures of liver fibrosis in predicting all-cause mortality in women with HIV/HCV coinfection. Design: We studied HCV/HIV coinfected women enrolled in the prospective, multicenter Women's Interagency HIV Study. Aspartate aminotransferase to platelet ratio and FIB-4 were used to identify women without fibrosis at all visits and women who progressed to severe fibrosis. Methods: Enhanced liver fibrosis (ELF), which utilizes direct measures of fibrosis, hyaluronic acid, procollagen III aminoterminal peptide and tissue inhibitor of matrix metalloproteinase was performed. Results: Included were 381 women with 2296 ELF measurements, with mean follow-up 8.3 ± 3.3 years. There were 134 deaths (60% with severe liver fibrosis). Receiver operator characteristic curves at fixed time windows prior to death or at end of follow-up showed that ELF was best at predicting mortality when tested within a year of death (area under the curve for ELF 0.85 vs. APRI 0.69, P < 0.0001 and vs. FIB-4 0.75, P = 0.0036); and 1–3 years prior (ELF 0.71 vs. APRI 0.61, P = 0.005 and vs. FIB-4 0.65, P = 0.06). Use of all three measures did not improve on ELF alone. In multivariate logistic regression models controlling for CD4 + cell count, HIV viral load, antiretroviral use and age, ELF continued to perform better than APRI and FIB-4. Conclusion: ELF predicted all-cause mortality and was superior to APRI and FIB-4 in HIV/HCV coinfected women. Abstract : Supplemental Digital Content is available in the text