Liver stiffness predicts clinical outcome in HIV/HCV-coinfected patients with compensated liver cirrhosis

Hepatology. 2012 Jan 25. doi: 10.1002/hep.25616. [Epub ahead of print]

Merchante N, Rivero-Juárez A, Téllez F, Merino D, Ríos-Villegas MJ, Márquez-Solero M, Omar M, Macías J, Camacho A, Pérez-Pérez M, Gómez-Mateos J, Rivero A, Pineda JA; on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI).

Source

Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla. nicolasmerchante@gmail.com.

Abstract

Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in 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 a 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-coinfected with compensated cirrhosis and provides additional prognostic information to that provided by CTP score. (HEPATOLOGY 2012.).

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