title: Enhanced liver fibrosis marker as a noninvasive predictor of mortality in HIV/hepatitis C virus-coinfected women from a multicenter study of women with or at risk for HIV.
abstract: OBJECTIVE
  Coinfection with hepatitis C virus (HCV) is a major cause of morbidity and mortality among individuals with HIV. Our objective was to assess the prognostic performance of noninvasive measures of liver fibrosis in predicting all-cause mortality in women with HIV/HCV coinfection.
  
  
  METHODS
  We studied HCV/HIV coinfected women enrolled in the prospective, multicenter Women's Interagency HIV Study. Aspartate aminotransferase to platelet ratio and FIB-4 were used to identify women without fibrosis at all visits and women who progressed to severe fibrosis.
  
  
  METHODS
  Enhanced liver fibrosis (ELF), which utilizes direct measures of fibrosis, hyaluronic acid, procollagen III aminoterminal peptide and tissue inhibitor of matrix metalloproteinase was performed.
  
  
  RESULTS
  Included were 381 women with 2296 ELF measurements, with mean follow-up 8.3 ± 3.3 years. There were 134 deaths (60% with severe liver fibrosis). Receiver operator characteristic curves at fixed time windows prior to death or at end of follow-up showed that ELF was best at predicting mortality when tested within a year of death (area under the curve for ELF 0.85 vs. APRI 0.69, P < 0.0001 and vs. FIB-4 0.75, P = 0.0036); and 1-3 years prior (ELF 0.71 vs. APRI 0.61, P = 0.005 and vs. FIB-4 0.65, P = 0.06). Use of all three measures did not improve on ELF alone. In multivariate logistic regression models controlling for CD4 cell count, HIV viral load, antiretroviral use and age, ELF continued to perform better than APRI and FIB-4.
  
  
  CONCLUSIONS
  ELF predicted all-cause mortality and was superior to APRI and FIB-4 in HIV/HCV coinfected women.
authors.affiliation: aUniversity of California San Francisco, San Francisco, CaliforniabCORE Center/Stroger Hospital of Cook County, Chicago, IllinoiscDepartment of Veterans Affairs Medical Center, San Francisco, CaliforniadGeorgetown University Medical Center, Washington, District of ColumbiaeWeill Cornell Medical College, New York, New YorkfState University of New York, Downstate Medical Center, Brooklyn, New YorkgJohns Hopkins Bloomberg School of Public Health, Baltimore, MarylandhUniversity of Southern California, Keck School of Medicine, Los Angeles, California, USAiDepartment of Public Health Sciences and Medical Statistics, University of Southampton, SouthamptonjInstitute for Liver and Digestive health, Division of Medicine, University College London, London, UK.
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Ross
authors.initials: R
authors.lastname: Boylan
authors.forename: Audrey L
authors.initials: AL
authors.lastname: French
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Michael W
authors.initials: MW
authors.lastname: Plankey
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Roksana
authors.initials: R
authors.lastname: Karim
authors.forename: Julie
authors.initials: J
authors.lastname: Parkes
authors.forename: William
authors.initials: W
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000032:analysis*; D060085:Coinfection / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology*; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases