title: Change in fibrosis score as a predictor of mortality among HIV-infected patients with viral hepatitis.
abstract: Noninvasive markers of liver fibrosis, measured at baseline, have been shown to predict liver-related mortality. It remains unknown if a change in the value of the scores over time predicts mortality in patients with HIV and viral hepatitis. In this retrospective study, survival in HIV/hepatitis B virus (HBV; n = 67), HIV/hepatitis C virus (HCV; n = 43), and HIV/HBV/HCV (n = 41) patients was examined using Kaplan-Meier life table analysis. Aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and FIB-4 scores, two noninvasive markers of liver fibrosis, were calculated at baseline and at last available clinical follow-up to determine the change in fibrosis score. Factors associated with mortality were assessed by Cox proportional hazards, including the change in the noninvasive marker score between the two time points. All-cause mortality was determined by Social Security Death Index and chart review. Sixty-seven were coinfected with HIV/HBV, 43 with HIV/HCV, and 41 were triply infected (HIV/HBV/HCV). Kaplan-Meier analysis showed similar survival for the three groups at 7 years of follow-up (p = 0.10). However, median length of follow-up was lower in HIV/HCV (60.5; range 0-102) compared to HIV/HBV (75.7; 12.3-126.5) and HIV/HBV/HCV (80.0; 2.7-123) months, respectively, p = 0.02. Baseline fibrosis score (p = 0.002), an increase in the value for noninvasive measurements for fibrosis (p < 0.001), and the presence of HIV/HCV coinfection (p = 0.041) were each associated with higher risk for mortality. Baseline fibrosis score (p = 0.03) and an increase in FIB-4 score (p = 0.05) were independent predictors of all-cause mortality, but liver-related mortality was not evaluated. In this study, baseline fibrosis score was predictive of 7-year all-cause mortality. Further studies are needed in a prospective cohort to evaluate the predictive value of monitoring changes in fibrosis scores over time to predict mortality in patients with viral hepatitis.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9113, USA. mamta.jain@utsouthwestern.edu
authors.forename: Mamta K
authors.initials: MK
authors.lastname: Jain
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Seremba
authors.forename: Rafia
authors.initials: R
authors.lastname: Bhore
authors.forename: Doan
authors.initials: D
authors.lastname: Dao
authors.forename: Reeti
authors.initials: R
authors.lastname: Joshi
authors.forename: Nahid
authors.initials: N
authors.lastname: Attar
authors.forename: He-Jun
authors.initials: HJ
authors.lastname: Yuan
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000201:enzymology / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000201:enzymology / Q000401:mortality / Q000473:pathology*; D006526:Hepatitis C / Q000201:enzymology / Q000401:mortality / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000201:enzymology / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase