Prognostic Value of Transient Elastography in Human Immunodeficiency Virus-Infected Patients With Chronic Hepatitis C
Leire Pérez-Latorre1, Antonio Rivero-Juárez2, Víctor Hontañón3
1Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
Insights
Liver stiffness accurately predicts liver-related events in HIV-infected patients with chronic hepatitis C. A liver stiffness measurement below 12 kPa indicates a low risk of developing liver complications within six years.
Area of Science:
- Hepatology
- Infectious Diseases
- Medical Prognostics
Background:
- Chronic hepatitis C (CHC) in HIV-infected individuals presents significant liver disease risks.
- Assessing liver stiffness (LS) is crucial for prognostic evaluation in this population.
Purpose of the Study:
- To determine the prognostic value of liver stiffness (LS) for predicting liver-related events (LRE) in HIV-infected patients with CHC.
- To establish LS as a reliable biomarker for risk stratification.
Main Methods:
- Analysis of HIV-infected patients with compensated CHC and LS measurements.
- Primary outcome: liver-related events (decompensation or hepatocellular carcinoma).
- Cohorts established for estimation and validation, excluding patients with sustained viral response.
Main Results:
- Liver stiffness demonstrated high accuracy in predicting LRE (AUROC 0.87-0.88).
- A liver stiffness cutoff of 12 kPa effectively ruled out LRE (98.3% negative predictive value).
- Increased hazard of LRE was observed with rising LS values above 12 kPa.
Conclusions:
- Liver stiffness is a highly accurate predictor of liver-related events in coinfected patients.
- LS <12 kPa indicates a low probability of LRE development over nearly 6 years.
- LS measurements provide valuable risk stratification for managing CHC in HIV-positive individuals.
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.
More Related Videos
10:12Establishment of the Dual Humanized TK-NOG Mouse Model for HIV-associated Liver Pathogenesis
Published on: September 11, 2019
07:32Author Spotlight: Investigating Immune Cell Dynamics in the Tumor Microenvironment — Challenges and Innovations in Cancer Prognosis
Published on: April 12, 2024