Prognostic Value of Transient Elastography in Human Immunodeficiency Virus-Infected Patients With Chronic Hepatitis C.
BACKGROUND
Our objective was to study the prognostic value of liver stiffness (LS) in HIV-infected patients with chronic hepatitis C (CHC).


METHODS
We analyzed HIV-infected patients with compensated CHC and at least 1 determination of LS. The primary outcome was the occurrence of liver-related events (LRE), namely, decompensation or hepatocellular carcinoma, whichever occurred first. We selected patients without sustained viral response (SVR) or end-of-treatment response (ETR) during follow-up and allocated them to an estimation cohort (EC) and a validation cohort (VC).


RESULTS
The study population comprised 1292 patients. After a median follow-up of 5.8 years, 90 patients experienced LRE and 73 died. In the subgroup of 957 patients without SVR or ETR, the area under the receiver operating characteristic curves (AUROCs) (95% confidence interval [CI]) of LS for prediction of LRE in the EC (n = 634) and the VC (n = 323) were 0.87 and 0.88, respectively. The best cutoff value of LS to rule out LRE in the EC was 12 kPa, with a negative predictive value of 98.3% in the EC and 98.2% in the VC. Per each 1 kPa and 5 kPa increase above 12 kPa, the hazard ratio of LRE (taking into account death as a competing risk) was 1.07 (95% CI, 1.05-1.08) and 1.38 (95% CI, 1.31-1.46), respectively.


CONCLUSIONS
Liver stiffness is very accurate for predicting LRE in coinfected patients. Patients with an LS <12 kPa had a 98% probability of not developing LRE after a median follow-up of almost 6 years. Above the 12-kPa cutoff, the hazard of LRE increases proportionally with LS.
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
Leire
L
Pérez-Latorre
Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba , Spain.
Antonio
A
Rivero-Juárez
Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid , Spain .
Víctor
V
Hontañón
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
Cristina
C
Díez
Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba , Spain.
Francisca
F
Cuenca
Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid , Spain .
Maria Luz
ML
Martín-Carbonero
Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid , Spain .
María L
ML
Montes
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
José M
JM
Bellón
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
Teresa
T
Aldámiz-Echevarría
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
Ana
A
Carrero
Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba , Spain.
Antonio
A
Rivero
Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid , Spain .
Juan
J
González-García
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain.
Juan
J
Berenguer
coinfection; hepatitis C; human immunodeficiency virus infection; liver stiffness; transient elastography.