The model for end-stage liver disease score is the best prognostic factor in human immunodeficiency virus 1-infected patients with end-stage liver disease: A prospective cohort study

Abstract

End-stage liver disease (ESLD) has become the main cause of mortality in patients coinfected by human immunodeficiency virus (HIV) and hepatitis B virus or hepatitis C virus in developed countries. The aim of this study was to describe the natural history of and prognostic factors for ESLD, with particular attention paid to features affecting liver transplantation. This was a prospective cohort study in 2 Spanish community-based hospitals performed between 1999 and 2004. One hundred four consecutive patients with cirrhosis and a first clinical decompensation of their chronic liver disease or hepatocellular carcinoma were included in the study. During a median follow-up of 10 months (endpoint: death, liver transplantation, or the last checkup date), 61 patients (59%) died. The probability of mortality (Kaplan-Meier method) at 1, 2, and 3 years was 43% [95% confidence interval (CI), 34%-60%], 59% (95% CI, 48%-70%), and 70% (95% Cl, 59%-81%), respectively. In a multivariate analysis, the Model for End-Stage Liver Disease (MELD) score and the inability to reach an undetectable plasma HIV-1 RNA viral load at any time during follow-up were the only variables independently associated with the risk of death (P Ͻ 0.001). Fifteen (14%) of the 104 patients were accepted for liver transplantation, although only 5 underwent the procedure, and 10 died while on the waiting list. The waiting list mortality rate in patients with a MELD score Ͻ 20 and in patients with a MELD score Ͼ20 was 58% and 100%, respectively (median follow-up, 5 months). In conclusion, HIV-1-infected patients with ESLD, especially those with poorly controlled HIV and a high MELD score, have a poor short-term outcome. The MELD score may be useful in deciding whether to indicate liver transplantation in these patients. However, because only a small proportion of the patients in this study were considered candidates for liver transplantation and most died while on the waiting list, few received a transplant.

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

“…In fact, the predictive value of MELD score in HIV/HCV-coinfected patients remains controversial, with previous studies reporting no independent association with survival 6,33 and others finding such an association. 34,35 In our opinion, the lack of an independent association of MELD with liver-related mortality in our cohort could reflect a weaker predictive value in the long term, as is the case in this study, than in the short-and mid-term. Achievement of SVR after treatment of hepatitis C is associated with a reduction in liver-related mortality in HIV-negative 36 and HIV-positive patients.…”

Hepatotoxicity after Sevoflurane Exposure in a Patient with Chronic Hepatitis C

“…These include [20], ascites (abdominal distention, shifting dullness, and confirmed fluid by paracentesis or abdominal imaging), variceal bleeding (endoscopic evaluation with upper gastrointestinal hemorrhage, 35-85% with cirrhosis; bleeding 25-40%; 30-50% 3 month survival), spontaneous bacterial peritonitis (>500 white blood cells/mL, >250 polymorphonuclear cells/mL, positive culture), hepatic hydrothorax (right sided pleural effusion), and hepatic encephalopathy (asterixis flapping tremor). Management requires aggressive diuresis, pleural taps, and immediate consideration for liver transplantation based on the MELD (Model for End Stage Liver Disease) [21].…”

Liver transplantation in human immunodeficiency virus-positive patients

“…The inability to achieve an undetectable plasma HIV RNA viral load before LT is associated with an increased risk of death [hazard ratio (HR) ¼ 3.47, 95% confidence interval (CI) ¼ 1.94-6.17, P < 0.001]. 46 It is important that patients undergoing an assessment for LT have adequate future cART treatment options that are based on their previous treatment history and HIV genotype resistance testing. Because of the hepatotoxicity associated with cART in patients with ESLD, some patients may not be able to tolerate antiretroviral therapy before LT.…”

“…Two more recent prospective studies 46,50 have suggested that the MELD score may be an important The criteria for LT are met. The CD4 þ cell count is >100 cells/lL (>200/lL if there is a history of opportunistic complications).…”

“…In the first study, Murillas et al 46 studied 104 patients with ESLD; the median follow-up time was 10.3 months. During this time, 61 patients died (59 because of liver-related problems), 15 patients were registered for LT, and 5 successfully underwent LT.…”