Prognostic Value of Transient Elastography in Human Immunodeficiency Virus-Infected Patients With Chronic Hepatitis C

Abstract

Background.Our objective was to study the prognostic value of liver stiffness (LS) in HIV-infected patients with chronic hepatitis C (CHC).Methods.We analyzed HIV-infected patients with compensated CHC and at least 1 determination of LS. The primary outcome was the occurrence of liver-related events (LRE), namely, decompensation or hepatocellular carcinoma, whichever occurred first. We selected patients without sustained viral response (SVR) or end-of-treatment response (ETR) during follow-up and allocated them to an estimation cohort (EC) and a validation cohort (VC).Results.The study population comprised 1292 patients. After a median follow-up of 5.8 years, 90 patients experienced LRE and 73 died. In the subgroup of 957 patients without SVR or ETR, the area under the receiver operating characteristic curves (AUROCs) (95% confidence interval [CI]) of LS for prediction of LRE in the EC (n = 634) and the VC (n = 323) were 0.87 and 0.88, respectively. The best cutoff value of LS to rule out LRE in the EC was 12 kPa, with a negative predictive value of 98.3% in the EC and 98.2% in the VC. Per each 1 kPa and 5 kPa increase above 12 kPa, the hazard ratio of LRE (taking into account death as a competing risk) was 1.07 (95% CI, 1.05–1.08) and 1.38 (95% CI, 1.31–1.46), respectively.Conclusions.Liver stiffness is very accurate for predicting LRE in coinfected patients. Patients with an LS <12 kPa had a 98% probability of not developing LRE after a median follow-up of almost 6 years. Above the 12-kPa cutoff, the hazard of LRE increases proportionally with LS.

Capacity of non-invasive hepatic fibrosis algorithms to replace transient elastography to exclude cirrhosis in people with hepatitis C virus infection: A multi-centre observational study

“…The pressure reading on TE in kilopascals (kPa) was used to define the degree of hepatic fibrosis including cirrhosis. In keeping with Australian guidelines [4], in mono-infected patients the kPa cut-off for cirrhosis was >12.5kPa, while patients with HIV or HBV co-infection were considered to have cirrhosis with kPa values of >12.0kPa [13, 28–29]. TE was undertaken by practitioners trained in its use.…”

Comparative evaluation of liver, spleen, and kidney stiffness in HIV-monoinfected pediatric patients via shear wave elastography

“…Coinfection increases liver damage and fibrosis. Pérez-Latorre et al [19] reported elevated liver stiffness in coinfected patients. They also concluded that stiffness values above 12 kPa can be used to determine liver fibrosis.…”

Update in HIV–hepatitis C virus coinfection in the direct acting antiviral era

“…A systematic review and meta-analysis in HIV/HCV co-infected persons, encompassing 6 studies, concluded TE had similar pooled sensitivity and specificity for prediction of liver-related events as in HCV mono-infection, with better performance in cirrhotics than those with intermediate stages of fibrosis, and with no impact of CD4 count on diagnostic accuracy [53]. A retrospective study of 957 HIV/HCV co-infected patients with compensated cirrhosis found that liver stiffness <12 kPa, measured by TE, had excellent negative predictive value for liver related events after a median follow up of 6 years, with a proportional increase in events for pressures above this cutoff [54]. In a cohort of 275 HIV/HCV co-infected patients with cirrhosis, a significant increase in liver stiffness measured by TE over a median follow-up time of 32 months was associated with a higher risk of hepatic decompensation and HCC [55].…”