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FIB-4, race predicts ESLD in HIV/HCV coinfected patients
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The Fibrosis-4 score and race were useful in quantifying the risk for end-stage liver disease among patients with both HIV and hepatitis C virus, according to recent findings.
In the retrospective cohort study, researchers evaluated 6,016 HIV/HCV coinfected individuals on ART who were enrolled in the Veterans Aging Cohort Study (VACS) from January 1997 to Sept. 30, 2010. To identify potential predictors of end-stage liver disease (ESLD), the researchers assessed baseline variables such as FIB-4, aspartate aminotransferase-to-platelet ratio index (APRI), BMI, severe anemia, CD4 cell count, HIV RNA greater than 400 copies/mL, alcohol dependence or abuse, diabetes mellitus, hepatitis B coinfection and race among the patients. Study follow-up commenced after 1 year of ART. The primary endpoint was ESLD, which was delineated as hepatic decompensation, hepatocellular carcinoma or liver-associated mortality.
During a median follow-up of 6.6 years, the researchers said 8.8% of the patients developed ESLD. A diagnosis suggestive of hepatic decompensation was recorded at the time of an initial ESLD event in 6.6% of patients, hepatocellular carcinoma was diagnosed in 1% and liver-related death occurred in 1.2% of the cohort.
The researchers found that baseline FIB-4, baseline APRI and nonblack race were most strongly associated with ESLD. Modest discrimination for ESLD was revealed in a model consisting of FIB-4 and race, and this model had higher net benefit compared with other approaches of treating no or all coinfected patients at relevant risk thresholds. In cases of FIB-4 greater than 3.25, ESLD risk ranged between 7.9% at 1 year to 26% at 5 years among nonblacks, and from 2.4% at 1 year to 14% at 5 years among black patients.
These findings may be useful in helping HIV/HCV coinfected patients at higher risk take preventive measures against progression to ESLD, according to the investigators.
“Such information could prompt coinfected patients to reduce their risk factors for liver disease progression and aid HCV treatment decisions for both clinicians and patients,” the researchers wrote. “Future studies should evaluate the classification performance of FIB-4 and race in other coinfected populations, compare the performance of FIB-4 using the established cut-off points vs. alternative thresholds, and determine if its use improves outcomes.” – by Jen Byrne
Disclosure: Lo Re III reports receiving investigator-initiated research grant support from AstraZeneca and Gilead Sciences. Please see the full study for a list of all other authors’ relevant financial disclosures.
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