Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

Abstract

on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS 40 kPa (P 5 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P 5 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P 5 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P 5 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P 5 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P 5 0.08) was of borderline significance. Conclusion: LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score. (HEPATOLOGY 2012;56:228-238)

Transient Elastography for Predicting Liver-Related Events in Cirrhotic HIV-Infected Patients

“…These new data are from very different patient populations, whose liver disease had diverse etiologies and characteristics. HIV coinfection is one of the areas where new evidence is similar to that reported for non-HIV-infected persons [9,[12][13][14]18].…”

“…We believe this difference is due to the characteristics of the study patients [12][13][14]. The patients analyzed had liver cirrhosis caused by long-standing viral hepatitis.…”

“…Despite its small sample size, our study has features that add particular interest with respect to other published studies [12][13][14]. First, patients with a sustained virological response to hepatitis C were excluded.…”

“…The first published study on the value of LSM for predicting liver events in HIV-infected patients was by Merchante et al [13], who included 239 subjects diagnosed with cirrhosis using LSM; more than half had a value >25 kPa. The clinical event rates reported are higher than those of our study, since the patients included had HCC and a significant percentage (39%) received treatment for HCV infection during follow-up, which could have caused further liver decompensation.…”

“…Findings suggest that LSM could be incorporated as a prognostic tool into the daily clinical care of patients with liver cirrhosis. Studies on HIV-infected patients are heterogeneous, and only that of Merchante et al [13] included a large, prospective cohort of HIV/HCV co-infected patients with compensated liver cirrhosis managed under a uniform management protocol.…”