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Liver stiffness more predictive of decompensation than biopsy results in HIV/HCV coinfection
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Liver stiffness measurement is similarly predictive of overall mortality and more predictive of decompensation than liver biopsy results among patients with HIV/HCV coinfection, according to data presented at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.
Researchers evaluated 297 patients coinfected with HCV and HIV who underwent liver biopsy (LB) and liver stiffness measurement (LSM) within 12 months of one another. The midway point between the procedures was considered the baseline date for analysis. Ninety-three percent of participants were receiving therapy with antiretrovirals at baseline, with undetectable plasma HIV RNA levels in 79% of cases and a median CD4 cell count of 514 cells/mcL.
Among evaluable participants after 26 cases were lost to follow-up, overall mortality across the cohort was 1.56 deaths per 100 person-years. Increased risk for death was associated with elevated LSM values (adjusted HR=1.28; 95% CI, 1.12-1.46 per 5 kPa increase) and fibrosis stage at baseline as indicated by LB (aHR=1.56; 95% CI, 1.02-2.4). Liver decompensation occurred at a rate of 1.59 cases per 100 person-years, with LSM (aHR=1.37; 95% CI, 1.21-1.54) and fibrosis stage at baseline (aHR=1.67; 95% CI, 1.15-2.43) as predictive factors.
Integrated discrimination improvement (IDI) analysis indicated that models incorporating LMS values performed 3.9% better in predicting mortality than models incorporating LB, but was not statistically significant (P=.072). For the prediction of liver decompensation, LMS-based models performed 8.4% better than LB-based models (P=.045).
“LSM-based prediction achieves a similar yield [to] LB-based models to predict overall mortality in HIV/HCV coinfected patients, and the former could better predict liver decompensations,” the researchers concluded. “LSM may replace LB as [a] prognostic tool in this setting.”
For more information:
Macías J. TUAB0104: Prediction of Survival and Decompensations of Cirrhosis Among HIV/HCV Coinfected Patients: A Comparison of Liver Stiffness Versus Liver Biopsy. Presented at: IAS Conference on HIV Pathogenesis, Treatment and Prevention; June 30-July 03, 2013; Kuala Lumpur, Malaysia.