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Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus‐coinfected patients with compensated liver cirrhosis
Author(s) -
Merchante Nicolás,
RiveroJuárez Antonio,
Téllez Francisco,
Merino Dolores,
José RíosVillegas Maria,
MárquezSolero Manuel,
Omar Mohamed,
Macías Juan,
Camacho Ángela,
PérezPérez Montserrat,
GómezMateos Jesús,
Rivero Antonio,
Antonio Pineda Juan
Publication year - 2012
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.25616
Subject(s) - medicine , decompensation , transient elastography , cirrhosis , liver disease , gastroenterology , liver transplantation , hepatitis c virus , hazard ratio , hepatitis c , coinfection , prospective cohort study , confidence interval , transplantation , immunology , virus , liver fibrosis
Abstract 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 = 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 = 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1‐50.4; P = 0.004) and baseline LS (HR 1.03; 95% CI 1.01‐1.05; P = 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 = 0.007) were independently associated with liver‐related death; baseline LS (HR 1.03; 95% CI 0.98‐1.07; P = 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. (H EPATOLOGY 2012;56:228–238)