title: The role of real-time ultrasonography in predicting esophageal varices in hemophiliacs co-infected with hepatitis C and human immunodeficiency virus.
abstract: OBJECTIVE
  Endoscopic procedures are the gold standard for the diagnosis of esophageal varices but these invasive methods are complex to perform in hemophilic patients co-infected with hepatitis C virus/human immunodeficiency virus (HCV/HIV). Real-time ultrasonography has been reported to be an effective, non-invasive procedure able to monitor patients with chronic liver disease and to give useful information for the diagnosis of liver cirrhosis, portal hypertension and the presence of esophageal varices.
  
  
  METHODS
  Seventy patients with severe hemophilia were evaluated by esophago-gastro-duodenoscopy (EGDS) and ultrasonography; 40 had HCV/HIV co-infection and 30, comparable for age and HCV exposure time, were HCV+/HIV-. Hepatic longitudinal diameter, splenic longitudinal diameter, portal vein diameter and the average speed of portal flow were measured. The congestion index was calculated.
  
  
  RESULTS
  Thirteen out of 40 (32.5%) HCV/HIV coinfected patients had esophageal varices. None out of 30 HCV+/HIV- patients had esophageal varices (p< 0.001). Univariate analysis showed that the 13 HCV/HIV coinfected patients with esophageal varices had significantly higher hepatic longitudinal diameter (p=0.006), splenic longitudinal diameter (p=0.0002), portal vein diameter (p=0.0005) and congestion index (p=0.0001) than did the remaining 27 HCV/HIV coinfected patients. The stepwise logistic regression analysis indicated that, of the various ultrasonographic parameters evaluated, splenic longitudinal diameter and portal vein diameter had the greatest diagnostic efficiency in diagnosing a high proportion of patients with esophageal varices. The diagnostic efficiency of the combined criterion expressed by the area under the ROC curve was 0.8803. Interpretation and Conclusions. Real-time ultrasonography, by evaluation of splenic longitudinal diameter and portal vein diameter, is an effective non-invasive technique able to classify correctly a large proportion of HCV/HIV co-infected hemophilic patients with esophageal varices.
authors.affiliation: Dept. of Biotecnologie Cellulari ed Ematologia, Univ. La Sapienza, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dragoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gentile
authors.forename: Claudio
authors.initials: C
authors.lastname: Cartoni
authors.forename: Flavia
authors.initials: F
authors.lastname: Chiarotti
authors.forename: Maria
authors.initials: M
authors.lastname: Puopolo
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Mazzucconi
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: De Matteis
authors.forename: Maria
authors.initials: M
authors.lastname: Pirillo
authors.forename: Pietro
authors.initials: P
authors.lastname: Martino
mesh_terms: D000328:Adult; D003199:Computer Systems; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D005189:False Positive Reactions; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006467:Hemophilia A / Q000150:complications*; D006487:Hemostasis; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D014463:Ultrasonography / Q000379:methods*