Predicting Risk of End-Stage Liver Disease in Antiretroviral-Treated Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients.
Background.  End-stage liver disease (ESLD) is an important cause of morbidity among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. Quantifying the risk of this outcome over time could help determine which coinfected patients should be targeted for risk factor modification and HCV treatment. We evaluated demographic, clinical, and laboratory variables to predict risk of ESLD in HIV/HCV-coinfected patients receiving antiretroviral therapy (ART). Methods.  We conducted a retrospective cohort study among 6016 HIV/HCV-coinfected patients who received ART within the Veterans Health Administration between 1997 and 2010. The main outcome was incident ESLD, defined by hepatic decompensation, hepatocellular carcinoma, or liver-related death. Cox regression was used to develop prognostic models based on baseline demographic, clinical, and laboratory variables, including FIB-4 and aspartate aminotransferase-to-platelet ratio index, previously validated markers of hepatic fibrosis. Model performance was assessed by discrimination and decision curve analysis. Results.  Among 6016 HIV/HCV patients, 532 (8.8%) developed ESLD over a median of 6.6 years. A model comprising FIB-4 and race had modest discrimination for ESLD (c-statistic, 0.73) and higher net benefit than alternative strategies of treating no or all coinfected patients at relevant risk thresholds. For FIB-4 >3.25, ESLD risk ranged from 7.9% at 1 year to 26.0% at 5 years among non-blacks and from 2.4% at 1 year to 14.0% at 5 years among blacks. Conclusions.  Race and FIB-4 provided important predictive information on ESLD risk among HIV/HCV patients. Estimating risk of ESLD using these variables could help direct HCV treatment decisions among HIV/HCV-coinfected patients.
Departments of Medicine ; Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics , Perelman School of Medicine, University of Pennsylvania , Philadelphia ; Medical Service , Philadelphia VA Medical Center , Pennsylvania.
Vincent
V
Lo Re
Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics , Perelman School of Medicine, University of Pennsylvania , Philadelphia.
Michael J
MJ
Kallan
VA Connecticut Healthcare System , West Haven ; Yale University School of Medicine , New Haven, Connecticut.
Janet P
JP
Tate
VA Connecticut Healthcare System , West Haven ; Yale University School of Medicine , New Haven, Connecticut.
Joseph K
JK
Lim
VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , California.
Matthew Bidwell
MB
Goetz
Chronic Viral Illness Service , McGill University Health Centre , Montreal , Canada.
Marina B
MB
Klein
Atlanta VA Medical Center and Emory University School of Medicine , Georgia.
David
D
Rimland
Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine , Baylor College of Medicine , Houston, Texas.
Maria C
MC
Rodriguez-Barradas
VA Pittsburgh Healthcare System , Pennsylvania ; Hamad Healthcare Quality Institute , Doha, Qatar ; Hamad Medical Corporation , Doha, Qatar.
Adeel A
AA
Butt
Washington DC VA Medical Center , George Washington University Medical Center , Washington, District of Columbia.
Cynthia L
CL
Gibert
James J. Peters VA Medical Center and Mt. Sinai School of Medicine , New York, New York.
Sheldon T
ST
Brown
Yale University School of Medicine , New Haven, Connecticut ; Yale School of Public Health , New Haven, Connecticut.
Lesley S
LS
Park
Yale University School of Medicine , New Haven, Connecticut ; Yale School of Public Health , New Haven, Connecticut.
Robert
R
Dubrow
Departments of Medicine.
K Rajender
KR
Reddy
Departments of Medicine.
Jay R
JR
Kostman
VA Connecticut Healthcare System , West Haven ; Yale University School of Medicine , New Haven, Connecticut.
Amy C
AC
Justice
Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics , Perelman School of Medicine, University of Pennsylvania , Philadelphia.
A Russell
AR
Localio
HIV; HIV/HCV coinfection; end-stage liver disease; hepatic decompensation; hepatitis C