Prognostic Value of Transient Elastography in Human Immunodeficiency Virus-Infected Patients With Chronic Hepatitis C. (3rd October 2016)

• Record Type: Journal Article
• Authors: Pérez-Latorre, Leire; Rivero-Juárez, Antonio; Hontañón, Víctor; Díez, Cristina; Cuenca, Francisca; Martín-Carbonero, Maria Luz; Montes, María L.; Bellón, José M.; Aldámiz-Echevarría, Teresa; Carrero, Ana; Rivero, Antonio; González-García, Juan; Berenguer, Juan
• Is Part Of: Open forum infectious diseases. Volume 3:Number 4(2016)
• Publication Date: 2016-10-03
• Subjects: coinfection -- hepatitis C -- human immunodeficiency virus infection -- liver stiffness -- transient elastography; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofw212
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Our objective was to study the prognostic value of liver stiffness (LS) in HIV-infected patients with chronic hepatitis C (CHC). Methods: We analyzed HIV-infected patients with compensated CHC and at least 1 determination of LS. The primary outcome was the occurrence of liver-related events (LRE), namely, decompensation or hepatocellular carcinoma, whichever occurred first. We selected patients without sustained viral response (SVR) or end-of-treatment response (ETR) during follow-up and allocated them to an estimation cohort (EC) and a validation cohort (VC). Results: The study population comprised 1292 patients. After a median follow-up of 5.8 years, 90 patients experienced LRE and 73 died. In the subgroup of 957 patients without SVR or ETR, the area under the receiver operating characteristic curves (AUROCs) (95% confidence interval [CI]) of LS for prediction of LRE in the EC (n = 634) and the VC (n = 323) were 0.87 and 0.88, respectively. The best cutoff value of LS to rule out LRE in the EC was 12 kPa, with a negative predictive value of 98.3% in the EC and 98.2% in the VC. Per each 1 kPa and 5 kPa increase above 12 kPa, the hazard ratio of LRE (taking into account death as a competing risk) was 1.07 (95% CI, 1.05–1.08) and 1.38 (95% CI, 1.31–1.46), respectively. Conclusions: Liver stiffness is very accurate for predicting LRE in coinfected patients. Patients with an LS <12 kPa had a 98% probability of not developing LRE after a median follow-up of almost 6 years. Above the 12-kPa cutoff, the hazard of LRE increases proportionally with LS.