Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis.
OBJECTIVE
It is recommended that patients with cirrhosis undergo endoscopic screening to rule out the presence of gastroesophageal varices: a noninvasive predictive method to identify cirrhotic patients with a very low risk of esophageal varices could potentially avoid unnecessary endoscopies.


METHODS
We studied in 85 HIV-infected patients with cirrhosis the association between the absence of esophageal varices and portal hypertensive gastropathy, assessed by endoscopy, and liver stiffness measurement by transient elastography. We analyzed other parameters related to portal hypertension and hepatic function.


RESULTS
Values of transient elastography and platelet count were significantly associated with absence of esophageal varices/portal hypertensive gastropathy. The area under the receiver operating characteristics curve [95% confidence interval (CI)] of transient elastography for the prediction of the absence of esophageal varices/portal hypertensive gastropathy was 0.7 (0.58-0.81). A liver stiffness measurement value less than 20 kPa was highly predictive of the absence of esophageal varices and portal hypertensive gastropathy. The combination of transient elastography (<20 kPa) and platelet count (>120 × 10 cells/l) had the highest negative predictive value (100%, CI 95% 77.2-100) for absence of esophageal varices and portal hypertensive gastropathy.


CONCLUSIONS
Transient elastography combined with platelet count is useful for predicting the absence of esophageal varices and portal hypertensive gastropathy and, therefore, avoid unnecessary diagnostic endoscopies in HIV-infected patients with liver cirrhosis.
HIV Unit, Servicio de Medicina Interna, Hospital La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain. mmontesr2001@yahoo.es
Maria L
ML
Montes Ramirez
Jose F
JF
Pascual-Pareja
Matilde
M
Sánchez-Conde
Jose I
JI
Bernardino De la Serna
Francisco X
FX
Zamora Vargas
Pilar
P
Miralles
Juan M
JM
Castro
Margarita
M
Ramírez
Isabel
I
Gutierrez
Juan
J
Gonzalez-García
Juan
J
Berenguer
Jose R
JR
Arribas López
D000328:Adult; D003938:Diagnostic Techniques, Digestive System; D054459:Elasticity Imaging Techniques; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000503:physiopathology; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies