Progression of Liver Stiffness Predicts Clinical Events in HIV/HCV-Coinfected Patients with Compensated Cirrhosis

Background

Our objective was to assess the predictive value of the changes of liver stiffness (LS) for clinical outcome in HIV/HCV-coinfected patients with compensated liver cirrhosis and a LS value < 40 kPa.

Methods

Prospective cohort of 275 HIV/HCV-coinfected patients with cirrhosis, no previous liver decompensation (LD) and LS < 40 kPa. The time from diagnosis to LD and/or hepatocellular carcinoma (HCC) and the predictors of this outcome were evaluated. Significant progression of LS was defined as an increase ≥ 30 % over the baseline value at any time during the follow-up.

Results

After a median (Q1-Q3) follow-up of 32 (20–48) months, 19 (6.9 %, 95 % CI: 3.8 %–9.9 %) patients developed a first LD and/or HCC. At the end of the follow-up, 247 (90 %) patients had undergone a further LS examination. Of them, 77 (31 %) patients had a significant progression of LS. The mean (SD) survival time free of LD and/or HCC was 67 (3) and 77 (1) months in patients with or without significant progression of LS (p = 0.01). Significant progression of LS was an independent predictor of LD and/or HCC (Adjusted Hazard Ratio 4.63; 95 % confidence interval: 1.34–16.02; p = 0.015).

Conclusions

Significant progression of LS is associated with a higher risk of clinical events in HIV/HCV-coinfected patients with compensated cirrhosis and LS < 40 kPa.

Below:  Distribution of patients according to the evolution of liver stiffness from baseline to the end of follow-up in the 247 patients who underwent a liver stiffness examination at the end of the follow-up

Below:  Liver stiffness and probability of liver-related events during follow-up. a Probability of remaining free of developing a hepatic decompensation and/or hepatocellular carcinoma according to baseline liver stiffness. LS, liver stiffness. kPa, KiloPascals. b Probability of remaining free of developing a hepatic decompensation and/or hepatocellular carcinoma according to the evolution of liver stiffness during the follow-up. Progressors are defined as those patients showing an increase of LS ≥ 30 % over the baseline value at any time during the follow-up

Full article at:  http://goo.gl/IXUV65

By:  Nicolás Merchante^1*, Francisco Téllez², Antonio Rivero-Juárez³, Maria José Ríos-Villegas⁴,Dolores Merino⁵, Manuel Márquez-Solero⁶, Mohamed Omar⁷, Eva Recio¹, Montserrat Pérez-Pérez², Ángela Camacho³, Sara Macías-Dorado⁴, Juan Macías¹, Sandra Lorenzo-Moncada², Antonio Rivero³, Juan A. Pineda¹ and on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)

¹Unidad Clínica de Enfermedades Infecciosas y Microbiología. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario de Valme, Avenida de Bellavista s/n, Sevilla, 41014, Spain

²Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología. Hospital de La Línea de la Concepción, AGS Campo de Gibraltar, Cádiz, Spain

³Unidad de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain

⁴Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen Macarena, Sevilla, Spain

⁵Unidad de Gestión Clínica de Enfermedades Infecciosas. Complejo Hospitalario de Huelva, Huelva, Spain

⁶Unidad de Gestión Clínica de Enfermedades Infecciosas. Hospital Virgen de la Victoria. Complejo Hospitalario de Málaga, Málaga, Spain

⁷Unidad de Enfermedades Infecciosas. Complejo Hospitalario de Jaén, Jaén, Spain

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