title: Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis.
abstract: Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS ≥ 40 kPa (P = 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P = 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P = 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P = 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P = 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P = 0.08) was of borderline significance.
  
  
  CONCLUSIONS
  LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score.
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain. nicolasmerchante@gmail.com
authors.forename: Nicolás
authors.initials: N
authors.lastname: Merchante
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero-Juárez
authors.forename: Francisco
authors.initials: F
authors.lastname: Téllez
authors.forename: Dolores
authors.initials: D
authors.lastname: Merino
authors.forename: Maria
authors.initials: M
authors.lastname: José Ríos-Villegas
authors.forename: Manuel
authors.initials: M
authors.lastname: Márquez-Solero
authors.forename: Mohamed
authors.initials: M
authors.lastname: Omar
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: Angela
authors.initials: A
authors.lastname: Camacho
authors.forename: Montserrat
authors.initials: M
authors.lastname: Pérez-Pérez
authors.forename: Jesús
authors.initials: J
authors.lastname: Gómez-Mateos
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.forename: Juan
authors.initials: J
authors.lastname: Antonio Pineda
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D015331:Cohort Studies; D060085:Coinfection / Q000175:diagnosis* / Q000453:epidemiology; D016001:Confidence Intervals; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology; D017093:Liver Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate