Noninvasive Detection of Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease

Vuille‐Lessard, Élise; Rodrigues, Susana; Berzigotti, Annalisa

doi:10.1016/j.cld.2021.01.005

Cited by 35 publications

(34 citation statements)

References 162 publications

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“…FIB-4 index was deeply influenced by age, whereas TE and APRI score were not. TE had the advantages over FIB-4 index and APRI score to be associated with portal hypertension and to be more accurate to detect advanced fibrosis in people affected by non-alcoholic fatty liver disease [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection

et al. 2021

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Severe liver fibrosis (LF) is associated with poor long-term liver-related outcomes in people living with HIV (PLWH). The study aimed to explore the prevalence and predictors of LF and the concordance between different non-invasive methods for the estimation of LF in HIV-infected individuals without hepatitis virus infection. We enrolled PLWH with HIV-1-RNA <50 copies/mL for >12 months, excluding individuals with viral hepatitis. LF was assessed by transient elastography (TE) (significant >6.65 kPa), fibrosis-4 (FIB-4) (significant >2.67), and AST-to-platelet ratio index (APRI) (significant >1.5). We included 234 individuals (67% males, median age 49 years, median time from HIV diagnosis 11 years, 38% treated with integrase strand transfer inhibitors). In terms of the TE, 13% had ≥F2 stage; FIB-4 score was >1.5 in 7%; and APRI > 0.5 in 4%. Higher body mass index, diabetes mellitus, detectable baseline HIV-1 RNA and longer atazanavir exposure were associated with higher liver stiffness as per TE. Predictors of higher APRI score were CDC C stage and longer exposure to tenofovir alafenamide, while HBcAb positivity and longer exposure to tenofovir alafenamide were associated to higher FIB-4 scores. Qualitative agreement was poor between FIB-4/TE and between APRI/TE by non-parametric Spearman correlation and kappa statistic. In our study, in the group of PLWH without viral hepatitis, different non-invasive methods were discordant in predicting liver fibrosis.

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Section: Discussionmentioning

confidence: 99%

Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection

et al. 2021

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“…13,18,21 Finally, at variance with our study design which adopted pretreatment parameters to stratify the patients, recent studies 22,23 showed that a post-treatment algorithm combining simple serum markers (albumin, von Willebrand/platelet count ratio) with TE enables a reliable risk stratification for the development of hepatic decompensation after SVR. Moreover, other non-invasive tests such as laboratory tests, spleen elastography, magnetic resonance-based techniques and subharmonic-aided pressure estimation (SHAPE) 24 alone or in combination seem promising approaches in evaluating CSPH but are still awaiting validation.…”

Section: Ta B L E 3 Association Between Baseline Characteristics and ...mentioning

confidence: 99%

Screening and surveillance of oesophageal varices in patients with HCV‐positive liver cirrhosis successfully treated by direct‐acting antiviral agents

Ciancio

Ribaldone

Salamone

et al. 2022

Liver International

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Background & Aims: limited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)-positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long-term prospective study on 427 HCV-positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs). Methods:Patients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow-up of 65.2 months according to Baveno VI recommendations.Results: About 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients (p < .0001). No patients belonging to Group 1 without baseline EV developed EV at follow-up endoscopy compared with 6.5% in Group 2 patients (p = .02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow-up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p = .001).Improvement in Baveno VI status was observed in 118/335 (35.2%, p < .0001) of Group 2 patients and among those without pre-therapy EV, none developed EV throughout the follow-up.

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“…Cirrhotic patients achieving SVR by DAAs show a progressive decrease in portal pressure during follow-up, reducing the incidence of decompensation events [52,[59][60][61]. However, clinically significant portal hypertension (CSPH) may persist in a significant proportion of them [62][63][64], and several noninvasive tests (NITs) are currently used to stratify cured patients in order to better individuate patients at risk for liver decompensation [65]. According to the recent EASL guidelines [49], in successfully treated HCV-positive cirrhotic patients, LSM by TE could be helpful to refine the stratification of the residual risk of liver-related complications, even though cured cirrhotic patients should continue to be monitored for HCC by abdominal ultrasound examination ± alphafetoprotein assay every 6 months irrespective of the results of NITs.…”

Section: Compensated Cirrhosismentioning

confidence: 99%

Therapy of Chronic Viral Hepatitis: The Light at the End of the Tunnel?

2022

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Chronic viral hepatitis determines significant morbidity and mortality globally and is caused by three main etiological actors (Hepatitis B Virus, Hepatitis C Virus, and Hepatitis D Virus) with different replicative cycles and biological behaviors. Thus, therapies change according to the different characteristics of the viruses. In chronic hepatitis B, long term suppressive treatments with nucleoside/nucleotide analogues have had a dramatic impact on the evolution of liver disease and liver-related complications. However, a conclusive clearance of the virus is difficult to obtain; new strategies that are able to eradicate the infection are currently objects of research. The therapy for Hepatitis D Virus infection is challenging due to the unique virology of the virus, which uses the synthetic machinery of the infected hepatocyte for its own replication and cannot be targeted by conventional antivirals that are active against virus-coded proteins. Recently introduced antivirals, such as bulevertide and lonafarnib, display definite but only partial efficacy in reducing serum HDV-RNA. However, in combination with pegylated interferon, they provide a synergistic therapeutic effect and appear to represent the current best therapy for HDV-positive patients. With the advent of Direct Acting Antiviral Agents (DAAs), a dramatic breakthrough has occurred in the therapeutic scenario of chronic hepatitis C. Cure of HCV infection is achieved in more than 95% of treated patients, irrespective of their baseline liver fibrosis status. Potentially, the goal of global HCV elimination by 2030 as endorsed by the World Health Organization can be obtained if more global subsidised supplies of DAAs are provided.

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Noninvasive Detection of Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease

Cited by 35 publications

References 162 publications

Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection

Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection

Screening and surveillance of oesophageal varices in patients with HCV‐positive liver cirrhosis successfully treated by direct‐acting antiviral agents

Therapy of Chronic Viral Hepatitis: The Light at the End of the Tunnel?

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