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Transient elastography accurately predicts liver-related events in HIV/HCV–coinfected patients
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Patients coinfected with HIV and hepatitis C virus with a liver stiffness value of less than 12 kPa had a 98% chance of not developing liver-related events, according to a recent data published in Open Forum Infectious Diseases.
“Having identified the 12-kPa cut-off as the threshold for identification of patients with a very low risk of progression, we found that the hazard of [liver-related events (LRE)] increased proportionally with liver stiffness value above this cut-off,” Leire Pérez-Latorre, MD, PhD, researcher in the infectious diseases unit of the Foundation for Biomedical Research at Gregorio Marañón University General Hospital, and colleagues wrote.
Transient elastography (TE) is a noninvasive and effective method for identifying clinical outcomes, including LRE. However, researchers wrote that “no validated prediction model based on TE has been developed for LRE in patients with chronic hepatitis C with or without cirrhosis, and very little is known about TE cut-offs for stratification of the risk of LRE.” Thus, Pérez-Latorre and colleagues investigated the prognostic value of liver stiffness in patients coinfected with HIV and chronic HCV.
The researchers conducted a retrospective study at three large Spanish teaching hospitals, using computerized TE records to identify patients aged 18 years and older who were coinfected with HIV and HCV and had at least one determination of liver stiffness.
The study included 1,292 patients (median age, 44 years; 78.6% men) who were followed from the date of the first TE measurement to the last follow-up visit or death.
The study’s primary outcome was the occurrence of LRE, specifically decompensation or hepatocellular carcinoma, whichever occurred first. Researchers first evaluated the independent role of TE in predicting LRE, considering death as a competitive risk in the full dataset of patients. After a median follow-up of 5.8 years, 90 patients experienced LRE and 73 died.
Then, researchers identified 957 patients who did not have a sustained viral response or end-of-treatment response during follow-up, allocating 634 patients to an estimation cohort and 323 to a validation cohort.
The area under the receiver operating characteristic curve (AUROC) of liver stiffness for the prediction of LRE in the estimation cohort was 0.82 and in the validation cohort, 0.88.
Of all possible values of liver stiffness up to 75 kPa, the researchers determined that the best cut-off value to rule out LRE in the estimation cohort was 12 kPa, with a negative predictive value of 98.3% (95% CI, 97.3-99.3) in the estimation cohort and 98.2% (95% CI, 96.8-99.7) in the validation cohort.
Above the 12 kPa cut-off, they found that the relationship between liver stiffness and rates of LRE was linear. For each 1 kPa increase above 12 kPa, the HR of LRE — considering death as a competing risk — was 1.07 (95% CI, 1.05-1.08). For each 5 kPa increase above the 12 kPa threshold, the HR of LRE was 1.38 (95% CI, 1.31-1.46).
The researchers noted that the proposed 12 kPa cut-off should be evaluated prospectively with large datasets and cost-effectiveness analyses before being endorsed for specific recommendations. Nevertheless, they claimed that their findings could have significant implications for practice.
“They show that TE is an excellent tool for stratifying the risk of liver-related outcomes in HIV/HCV–coinfected patients and suggest that those with a liver stiffness below the 12 kPa cutoff could be followed up less closely than patients with higher liver stiffness values,” they concluded. – by Sarah Kennedy
Disclosure: The researchers report no relevant financial disclosures.
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