Open AccessIncreased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study
Author(s) -
Sarah Shili-Masmoudi,
Philippe Sogni,
Victor de Lédinghen,
Laure Esterle,
MarcAntoine Valantin,
Isabelle PoizotMartin,
Anne Simon,
Éric Rosenthal,
Karine Lacombe,
Gilles Pialoux,
Olivier Bouchaud,
Anne Gervais-Hasenknoff,
Cécile Goujard,
Lionel Piroth,
David Zucman,
Stéphanie Dominguez,
François Raffi,
Laurent Alric,
Firouzé BaniSadr,
Caroline Lascoux-Combe,
D. Garipuy,
Patrick Miailhes,
D. Vittecoq,
Claudine Duvivier,
Hugues Aumaître,
Didier Néau,
Philippe Morlat,
François Dabis,
Dominique Salmon,
Linda Wittkop
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0211286
Subject(s) - medicine , proportional hazards model , hazard ratio , cohort , prospective cohort study , human immunodeficiency virus (hiv) , gastroenterology , cohort study , hepatitis c , immunology , confidence interval
Background The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study. Methods HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ≥1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates. Results 1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4–49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2–6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM ≤12.5 kPa and 10.8% for patients with LSM >12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p<0.0001), history of HCV treatment (aHR = 0.53 [0.32; 0.90], p = 0.01) and smoking (past (aHR = 5.69 [1.56; 20.78]) and current (3.22 [0.93; 11.09]) versus never, p = 0.01) were associated with all-cause mortality independently of SVR, age, sex, alcohol use and metabolic disorders. Conclusion Any LSM >12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR.