title: Assessing mortality in women with hepatitis C virus and HIV using indirect markers of fibrosis.
abstract: OBJECTIVE
  Co-infection with hepatitis C virus (HCV) is a major cause of morbidity and mortality in HIV-infected individuals. However, predictors of mortality are poorly defined and most studies have focused predominantly on co-infection in men. We evaluated whether two indirect markers of hepatic fibrosis, aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 scores, were predictive of mortality in a well defined longitudinal cohort of HCV/HIV-co-infected women on HAART.
  
  
  METHODS
  HCV/HIV-co-infected women on antiretroviral therapy enrolled in Women's Interagency HIV Study (WIHS), a National Institutes of Health-funded prospective, multicenter, cohort study of women with and at risk for HIV infection were included. Using Cox regression analysis, associations between APRI and FIB-4 with all-cause mortality were assessed.
  
  
  RESULTS
  Four hundred and fifty HCV/HIV-co-infected women, of whom 191 women died, had a median follow-up of 6.6 years and 5739 WIHS visits. Compared with women with low APRI or FIB-4 levels, severe fibrosis was significantly associated with an increased risk of all-cause mortality {APRI: hazard ratio 2.78 [95% confidence interval (CI) 1.87, 4.12]; FIB-4: hazard ratio 2.58 (95% CI 1.68, 3.95)}. Crude death rates per 1000 patient-years increased with increasing liver fibrosis: 34.8 for mild, 51.3 for moderate and 167.9 for severe fibrosis as measured by FIB-4. Importantly, both APRI and FIB-4 increased during the 5 years prior to death for all women: the slope of increase was greater for women dying a liver-related death compared with nonliver-related death.
  
  
  CONCLUSIONS
  Both APRI and FIB-4 are independently associated with all-cause mortality in HCV/HIV-co-infected women and may have clinical prognostic utility among women with HIV and HCV.
authors.affiliation: University of California San Francisco, San Francisco, California 94143-0538, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Bambha
authors.forename: Christopher
authors.initials: C
authors.lastname: Pierce
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Audrey L
authors.initials: AL
authors.lastname: French
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Sharp
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.forename: Maria C
authors.initials: MC
authors.lastname: Villacres
authors.forename: Michael
authors.initials: M
authors.lastname: Plankey
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006526:Hepatitis C / Q000150:complications / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000401:mortality*; D008137:Longitudinal Studies; D008875:Middle Aged; D010976:Platelet Count; D016016:Proportional Hazards Models; D012307:Risk Factors; D019562:Viral Load
chemical_list: D001219:Aspartate Aminotransferases