title: Liver stiffness measurement versus liver biopsy to predict survival and decompensations of cirrhosis among HIV/hepatitis C virus-coinfected patients.
abstract: OBJECTIVE
  To compare the prognostic performance of liver biopsy with that of liver stiffness measurement (LSM) to predict survival and liver decompensations among HIV/hepatitis C virus (HCV)-coinfected patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Cohort of 297 HIV/HCV-coinfected patients, who underwent a liver biopsy and LSM separated by 12 months or less, followed in 10 Spanish tertiary care centers from December 2005 to December 2011 (median follow-up, 5 years; interquartile range, 4.2-5.4 years). Liver biopsies were staged following the Scheuer's score. LSM was obtained by hepatic transient elastometry. A survival analysis was carried out and the integrated discrimination improvement was computed to compare the ability of the survival models to predict outcomes. The incidence of death from any cause and of development of the first decompensation of cirrhosis was calculated.
  
  
  RESULTS
  Overall mortality rate was 1.63 [95% confidence interval (CI) 1.06-2.49] per 100 person-years. The adjusted hazard ratio [AHR (95% CI)] of baseline fibrosis (per stage of fibrosis) was 1.52 (1.08-2.15, P=0.017) and of LSM (per 5 kPa increase) 1.28 (1.12-1.46, P<0.001). LSM including models yielded a performance 3.9% better than the liver biopsy-based models (P=0.072). For the prediction of liver decompensations, the AHR (95% CI) of baseline fibrosis by liver biopsy (per stage of fibrosis) was 1.67 (1.15-2.43, P=0.007) and of LSM (per 5 kPa increase) 1.37 (1.21-1.54, P<0.001). LSM-based models yielded a performance 8.4% better than the liver biopsy-based models (P=0.045).
  
  
  CONCLUSIONS
  LSM-based prediction achieves a similar yield than liver biopsy-based models to predict overall mortality in HIV/HCV-coinfected patients. Models including LSM could predict better liver decompensations than liver biopsy.
authors.affiliation: aInfectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla, Seville bInfectious Diseases Unit, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Cordoba cInfectious Diseases Unit, Hospital Donostia, San Sebastian dInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville eInfectious Diseases Unit, Hospital General Universitario de Valencia, Valencia fInternal Medicine Service, FundacióLluita Contra la SIDA, University Hospital GermansTrias I Pujol, UniversitatAutònoma de Barcelona, Barcelona gInfectious Diseases Unit, Hospital Universitario Virgen Macarena, Seville hInfectious Diseases Unit, Complejo Hospitalario de Huelva, Huelva iInfectious Diseases Unit, Hospital de La Línea de la Concepción, Cadiz jInfectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: Angela
authors.initials: A
authors.lastname: Camacho
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Von Wichmann
authors.forename: Luis F
authors.initials: LF
authors.lastname: López-Cortés
authors.forename: Enrique
authors.initials: E
authors.lastname: Ortega
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ríos
authors.forename: Dolores
authors.initials: D
authors.lastname: Merino
authors.forename: Francisco
authors.initials: F
authors.lastname: Téllez
authors.forename: Manuel
authors.initials: M
authors.lastname: Márquez
authors.forename: María
authors.initials: M
authors.lastname: Mancebo
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D060085:Coinfection; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D017093:Liver Failure / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis