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Liver-related Events in Human Immunodeficiency Virus-infected Persons With Occult Cirrhosis

Amine Benmassaoud1, Roy Nitulescu2, Thomas Pembroke1,3

  • 1Division of Gastroenterology and Hepatology, Royal Victoria Hospital.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 19, 2018
PubMed

Insights

Occult cirrhosis (OcC) in human immunodeficiency virus (HIV)-infected patients significantly increases liver-related events. Early recognition and enhanced surveillance are crucial for better outcomes in these patients.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Human immunodeficiency virus (HIV)-infected patients face elevated liver-related mortality risks.
  • The impact of occult cirrhosis (OcC), a preclinical compensated stage without clinical signs, on liver events remains unclear.

Purpose of the Study:

  • To investigate the incidence of liver-related events in HIV-infected patients with and without cirrhosis.
  • To determine the association of occult cirrhosis (OcC) and overt cirrhosis (OvC) with liver-related events.
  • To evaluate hepatocellular carcinoma (HCC) screening rates in patients with OcC and OvC.

Main Methods:

  • Transient elastography (TE) classified 1092 HIV-infected patients into noncirrhotic, OcC (TE ≥13 kPa, no clinical signs), and OvC (TE ≥13 kPa, clinical signs) groups.
  • Kaplan-Meier and Cox regression analyses assessed incidence and risk factors of liver-related events.
  • Hepatocellular carcinoma (HCC) monitoring rates were compared between OcC and OvC groups.

Main Results:

  • The prevalence of OcC and OvC was 2.7% and 10.7%, respectively.
  • Incidence of liver events per 1000 person-years was 3.4 in noncirrhotic, 34.0 in OcC, and 37.0 in OvC patients.
  • Both OcC (aHR, 7.1) and OvC (aHR, 8.5) were independently linked to liver-related events. HCC monitoring was lower in OcC (24%) than OvC (40%).

Conclusions:

  • HIV-infected patients with occult cirrhosis (OcC) exhibit a high incidence of liver-related events.
  • Earlier recognition and enhanced surveillance strategies are essential for improving outcomes in HIV patients with OcC.
  • The findings underscore the need for targeted screening protocols for occult cirrhosis in HIV-infected populations.
Abstract

Keywords:
HCC surveillanceHIVliver-related eventsoccult cirrhosistransient elastography

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