Change in Fibrosis Score as a Predictor of Mortality Among HIV-Infected Patients with Viral Hepatitis

Abstract

Noninvasive markers of liver fibrosis, measured at baseline, have been shown to predict liver-related mortality. It remains unknown if a change in the value of the scores over time predicts mortality in patients with HIV and viral hepatitis. In this retrospective study, survival in HIV/hepatitis B virus (HBV; n = 67), HIV/hepatitis C virus (HCV; n = 43), and HIV/HBV/HCV (n = 41) patients was examined using Kaplan-Meier life table analysis. Aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and FIB-4 scores, two noninvasive markers of liver fibrosis, were calculated at baseline and at last available clinical follow-up to determine the change in fibrosis score. Factors associated with mortality were assessed by Cox proportional hazards, including the change in the noninvasive marker score between the two time points. All-cause mortality was determined by Social Security Death Index and chart review. Sixty-seven were coinfected with HIV/HBV, 43 with HIV/HCV, and 41 were triply infected (HIV/HBV/HCV). Kaplan-Meier analysis showed similar survival for the three groups at 7 years of follow-up ( p = 0.10). However, median length of follow-up was lower in HIV/HCV (60.5; range 0-102) compared to HIV/HBV (75.7; 12.3-126.5) and HIV/HBV/HCV (80.0; 2.7-123) months, respectively, p = 0.02. Baseline fibrosis score ( p = 0.002), an increase in the value for noninvasive measurements for fibrosis ( p < 0.001), and the presence of HIV/HCV coinfection ( p = 0.041) were each associated with higher risk for mortality. Baseline fibrosis score ( p = 0.03) and an increase in FIB-4 score ( p = 0.05) were independent predictors of all-cause mortality, but liver-related mortality was not evaluated. In this study, baseline fibrosis score was predictive of 7-year all-cause mortality. Further studies are needed in a prospective cohort to evaluate the predictive value of monitoring changes in fibrosis scores over time to predict mortality in patients with viral hepatitis.

Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis

“…We restricted our laboratory results to those obtained in the outpatient setting to mitigate these effects and the large sample size of our cohort likely offset this variability. Despite these limitations, FIB-4 has been shown to predict liver-related outcomes such as hepatic decompensation 26 and death 15,16 and to out-perform liver biopsy in this regard. 15 It is possible that thrombocytopenia due to immune dysregulation or marrow suppression from advanced HIV disease rather than from liver disease resulted in FIB-4 elevation in some cases.…”

“…FIB-4 ≥3.25 is a well-validated threshold shown to be predictive not only of advanced fibrosis, but also of liver-related clinical outcomes and overall mortality. 15,16 Accounting for multiple risk factors for fibrosis, we sought to determine the role of HIV disease severity in the progression of liver disease among those with and without viral hepatitis.…”

Annual Change in FIB-4, but not in APRI, was a Strong Predictor for Liver Disease Progression in Chinese Patients with Chronic Hepatitis C

“…AC of APRI was not associated with disease progression in multivariable analysis in this study. Previous studies have also pointed to the limited value of change in APRI in predicting liver disease progression (20,22). FIB-4 contains age (a strong predictive factor of overall survival), AST, ALT, and platelet count; thus, it is considered a more complex and better prognostic indicator than APRI for evaluating the progression of liver-related diseases.…”

“…Clinical disease evolves over time. Jain MK et al and Bambha K et al reported that increases in FIB-4 and APRI were correlated with outcomes in patients co-infected with HIV and viral hepatitis (22,23). Vergniol J et al reported that 3-year changes of noninvasive fibrosis methods have strong prognostic value in CHC patients (20).…”

The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals

“…The Fibrosis-4 (FIB-4) index, derived from age, liver aminotransferases and platelet count, is more widely available than biopsy, and has been shown to predict liver-related events and death in patients with chronic hepatitis C virus infection (HCV), HIV and HIV/HCV co-infection (9–12). …”