Background & Aims: Several non-invasive tests (NITs) have been developed to diagnose oesophageal varices (EV), including the recent Baveno VI criteria to rule out high-risk varices (HRV). Spleen stiffness measurement (SSM) with the standard FibroScan® (SSM@50Hz) has been evaluated. However, the EV grading could be underestimated because of a ceiling threshold (75 kPa) of the SSM@50Hz. The aims were to evaluate SSM by a novel spleen-dedicated FibroScan® (SSM@100Hz) for EV diagnosis compared with SSM@50Hz, other validated NITs and Baveno VI criteria.Methods: This prospective multicentre study consecutively enrolled patients with chronic liver disease; blood data, endoscopy, liver stiffness measurement (LSM), SSM@50Hz and SSM@100Hz were collected.Results: Two hundred and sixty patients met inclusion criteria. SSM@100Hz success rate was significantly higher than that of SSM@50Hz (92.5% vs 76.0%, P < .001). SSM@100Hz accuracy for the presence of EV (AUC = 0.728) and HRV (AUC = 0.756) was higher than in other NITs. SSM@100Hz AUC for large EV (0.782) was higher than SSM@50Hz (0.720, P = .027). AUC for HRV with SSM@100Hz (0.780) was higher than with LSM (0.615, P < .001). The spared endoscopy rate of Baveno VI criteria (8.1%) was significantly increased by the combination to SSM@50Hz (26.5%) or SSM@100Hz (38.9%, P < .001 vs others). The missed HRV rate was, respectively, 0% and 4.7% for combinations.Conclusions: SSM@100Hz is a new performant non-invasive marker for EV and HRV providing a higher accuracy than SSM@50Hz and other NITs. The combination of Baveno VI criteria and SSM@100Hz significantly increased the spared endoscopy
Background
In settings with high tuberculosis prevalence, 15–30% of HIV-infected individuals initiating antiretroviral therapy (ART) have undiagnosed tuberculosis. Such patients are usually screened by symptoms and sputum smear, which have poor sensitivity.
Objective
To project the clinical and economic outcomes of using Xpert MTB/RIF(Xpert), a rapid tuberculosis/rifampicin-resistance diagnostic, to screen individuals initiating ART.
Design
We used a microsimulation model to evaluate the clinical impact and cost-effectiveness of alternative TB screening modalities -in all patients or only symptomatic patients - for hypothetical cohorts of individuals initiating ART in South Africa (mean CD4 171/μL; tuberculosis prevalence 22%). We simulated no active screening and four diagnostic strategies: 1) smear microscopy (sensitivity 23%); 2) smear and culture (sensitivity, 100%); 3) one Xpert sample (sensitivity in smear-negative tuberculosis: 43%); 4) two Xpert samples (sensitivity in smear-negative tuberculosis: 62%). Outcomes included projected life expectancy, lifetime costs (2010 USD), and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs <$7,100 (South African gross domestic product per capita) were considered very cost-effective.
Results
Compared with no screening, life expectancy in tuberculosis-infected patients increased by 1.6 months using smear in symptomatic patients and by 6.6 months with 2 Xpert samples in all patients. At 22% tuberculosis prevalence, the ICER of smear for all patients was $2,800/year of life saved (YLS), and of Xpert (2 samples) for all patients was $5,100/YLS. Strategies involving one Xpert sample or symptom screening were less efficient.
Conclusions
Model-based analysis suggests that screening all individuals initiating ART in South Africa with two Xpert samples is very cost-effective.
CVD risks should be a part of treatment evaluation among PLWH. CVD prevention strategies could offer important health benefits for PLWH and should be evaluated.
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