title: Prediction of liver complications in patients with hepatitis C virus-related cirrhosis with and without HIV coinfection: comparison of hepatic venous pressure gradient and transient elastography.
abstract: BACKGROUND
  Hepatic venous pressure gradient (HVPG) is the best indicator of prognosis in patients with compensated cirrhosis. We compared HVPG and transient elastography (TE) for the prediction of liver-related events (LREs) in patients with hepatitis C virus (HCV)-related cirrhosis with or without human immunodeficiency virus (HIV) coinfection.
  
  
  METHODS
  This was a retrospective review of all consecutive patients with compensated HCV-related cirrhosis who were assessed simultaneously using TE and HVPG between January 2005 and December 2011. We used receiver operating characteristic (ROC) curves to determine the ability of TE and HVPG to predict the first LRE (liver decompensation or hepatocellular carcinoma).
  
  
  RESULTS
  The study included 60 patients, 36 of whom were coinfected with HIV. After a median follow-up of 42 months, 6 patients died, 8 experienced liver decompensations, and 7 were diagnosed with hepatocellular carcinoma. The area under the ROC curve (AUROC) of TE and HVPG for prediction of LREs in all patients was 0.85 (95% confidence interval [CI], .73-.97) and 0.76 (95% CI, .63-.89) (P = .13); for HIV-infected patients, the AUROC was 0.85 (95% CI, .67-1.00) and 0.81 (95% CI, .64-.97) (P = .57); and for non-HIV-infected patients, the AUROC was 0.88 (95% CI, .75-1.00) and 0.77 (95% CI, .57-.97) (P = .19). Based on the AUROC values, 2 TE cutoff points were chosen to predict the absence (<25 kPa) or presence (≥40 kPa) of LREs, thus enabling correct classification of 82% of patients.
  
  
  CONCLUSIONS
  Our data suggest that TE is at least as valid as HVPG for predicting LREs in patients with compensated HCV-related cirrhosis with or without concomitant HIV coinfection.
authors.affiliation: Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón.
authors.forename: Leire
authors.initials: L
authors.lastname: Pérez-Latorre
authors.forename: Matilde
authors.initials: M
authors.lastname: Sánchez-Conde
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.forename: Pilar
authors.initials: P
authors.lastname: Miralles
authors.forename: Teresa
authors.initials: T
authors.lastname: Aldámiz-Echevarría
authors.forename: Ana
authors.initials: A
authors.lastname: Carrero
authors.forename: Francisco
authors.initials: F
authors.lastname: Tejerina
authors.forename: Cristina
authors.initials: C
authors.lastname: Díez
authors.forename: José María
authors.initials: JM
authors.lastname: Bellón
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D060085:Coinfection / Q000150:complications / Q000473:pathology; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D017093:Liver Failure / Q000175:diagnosis* / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies
keywords: HIV infection; cirrhosis; end-stage liver disease; hepatic venous pressure gradient transient elastography; portal hypertension