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Oh JH, Goh MJ, Park Y, Kim J, Kang W, Sinn DH, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Paik YH. Different Performance of Liver Stiffness Measurement According to Etiology and Outcome for the Prediction of Liver-Related Events. Dig Dis Sci 2021; 66:2816-2825. [PMID: 32897445 DOI: 10.1007/s10620-020-06591-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS Liver stiffness measurement (LSM) by transient elastography (TE) has shown promising results for prediction of hepatocellular carcinoma (HCC) and hepatic decompensation in patients with chronic liver disease (CLD). However, whether prognostic performance of TE differs according to etiology or type of outcome remains further clarification. METHODS Performance of LSM for the prediction of HCC and hepatic decompensation was analyzed in a cohort of 4026 patients with asymptomatic CLD. RESULTS During median 4.5 years of follow-up (range 3.0-6.2 years), liver-related events (LRE) were observed in 196 patients (166 with HCC, 45 with hepatic decompensation, and 15 with both). In the multivariate analysis, LSM was independent factor associated with LRE and showed high AUROC (0.78). When stratified by type of outcome and etiology of liver disease, LSM showed high AUROC for the prediction of HCC for patients with non-viral hepatitis (0.89), while it showed relatively low AUROC for the prediction of HCC for patients with viral hepatitis (0.75). For the prediction of hepatic decompensation, LSM showed high AUROC for patients with both viral- and non-viral hepatitis (0.90, 0.90, respectively). CONCLUSIONS LSM showed powerful prognostic role for the prediction of LRE in patients with CLD. Notably, HCC risk was not negligible in patients with viral hepatitis who showed LSM value < 10 kPa, indicating watchful attention for HCC is still needed for viral hepatitis patients with low LSM.
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Affiliation(s)
- Joo Hyun Oh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Myung Ji Goh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yewan Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jihye Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Moon Seok Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Kwang Cheol Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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Liver stiffness and fibrosis-4 alone better predict liver events compared with aspartate aminotransferase to platelet ratio index in a cohort of human immunodeficiency virus and hepatitis C virus co-infected patients from ANRS CO13 HEPAVIH cohort. Eur J Gastroenterol Hepatol 2019; 31:1387-1396. [PMID: 31033848 DOI: 10.1097/meg.0000000000001408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES HIV/hepatitis C virus (HCV) co-infection leads to major complications, and noninvasive markers developed to stage liver fibrosis could be used as prognostic markers. We aimed to compare the performances of liver stiffness (LS), fibrosis-4 (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) to predict liver-related events in HIV/HCV co-infected patients. PATIENTS AND METHODS HIV/HCV co-infected patients from the ANRS CO13 HEPAVIH cohort were included if they had LS, FIB-4, and APRI measurements done in a window of 3 months. Primary outcome was the time between inclusion and occurrence of a liver-related event. Univariable and multivariable Fine and Gray models were performed. Predictive performances were compared by the area under the receiver operating characteristic (AUROC) differences after correction of optimistic by bootstrap samples. Best cutoffs to predict liver-related events were estimated by sensitivity and specificity maximization. RESULTS A total of 998 patients were included. Overall, 70.7% were men. Their median age was 46.8 years. According to LS value, 204 (20.4%) patients had cirrhosis. Overall, 39 patients experienced at least one liver-related event. In univariable analysis, LS AUROC curve was significantly superior to FIB-4 and APRI AUROC curves, being 87.9, 78.2, and 75.0%, respectively. After adjustment on age, CD4 levels, and insulin resistance, no differences were observed. The best cutoffs to identify patients at low or high risk of liver-related events were below 8.5, 1.00, and 0.35 and above 16.5, 4.00, and 1.75 for LS, FIB-4, and APRI, respectively. CONCLUSION To predict HCV-related events, APRI had lower performance than LS and FIB-4. FIB-4 is as good as LS to predict HCV-related events, suggesting that it can be used for the management of HIV/HCV co-infected patients and replace LS.
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Shen Y, Wu SD, Wu L, Wang SQ, Chen Y, Liu LL, Li J, Yang CQ, Wang JY, Jiang W. The prognostic role of liver stiffness in patients with chronic liver disease: a systematic review and dose-response meta-analysis. Hepatol Int 2019; 13:560-572. [PMID: 31273618 DOI: 10.1007/s12072-019-09952-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/18/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Liver stiffness measurement (LSM) by transient elastography (TE) has been assessed for the evaluation of clinically relevant outcomes in patients with chronic liver diseases (CLDs) while with variable results. This systematic review and meta-analysis aims to investigate the relationship between baseline LSM by TE and the development of clinically relevant outcomes. METHODS The systematic review identified eligible cohorts reporting the association between baseline LSM by TE and risk of hepatic carcinoma (HCC), hepatic decompensation (HD), all-cause and/or liver-related mortality and liver-related events (LREs) in CLD patients. Summary relative risks (RRs) with 95% confidence intervals (CIs) were estimated using a random-effect model. The dose-response association was evaluated by generalized least squares trend (Glst) estimation and restricted cubic splines. Commands of GLST, MKSPLINE, MVMETA were applied for statistical analysis. RESULTS 62 cohort studies were finally included, reporting on 43,817 participants. For one kPa (kilopascal) increment in baseline liver stiffness (LS), the pooled RR (95% CI) was 1.08 (1.05-1.11) for HCC, 1.08 (1.06-1.11) for all-cause mortality, 1.11 (1.05-1.17) for liver-related mortality, 1.08 (1.06-1.10) for HD and 1.07 (1.04-1.09) for LREs. Furthermore, the nonlinear dose-response analysis indicated that the significant increase in the risk of corresponding clinically relevant outcomes turned to a stable increase or a slight decrease with increasing baseline LS changing primarily in the magnitude of effect rather than the direction. CONCLUSIONS The dose-response meta-analysis presents a combination between the levels of baseline LS and RRs for each clinically relevant outcome. TE, which is noninvasive, might be a novel strategy for risk stratification and identification of patients at high risk of developing these outcomes.
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Affiliation(s)
- Yue Shen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China
| | - Sheng-Di Wu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China
| | - Ling Wu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China
| | - Si-Qi Wang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China
| | - Yao Chen
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li-Li Liu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China
| | - Jing Li
- Department of Gastroenterology, Tongji Hospital, Tongji University, Shanghai, People's Republic of China
| | - Chang-Qing Yang
- Department of Gastroenterology, Tongji Hospital, Tongji University, Shanghai, People's Republic of China
| | - Ji-Yao Wang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China
| | - Wei Jiang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, People's Republic of China.
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Liver stiffness measurement predicts liver-related events in patients with chronic hepatitis C: A retrospective study. PLoS One 2017; 12:e0184404. [PMID: 28880930 PMCID: PMC5589221 DOI: 10.1371/journal.pone.0184404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
The management of patients with chronic hepatitis C (CHC) depends on their clinical stage. Thus, noninvasive early recognition of patients with CHC at high risk for developing liver-related events (LREs) is important because it ensures optimal preventative management strategies may be employed that can affect the course of CHC disease. Our aim was to determine whether liver stiffness measurement (LSM) in hepatitis C virus (HCV)-infected patients is associated with a risk of LREs, particularly in cirrhotic patients. We carried out a retrospective study on 343 HCV-infected patients stratified according to cirrhosis (LSM<12.5 kPa vs. LSM≥12.5 kPa), and the cirrhotic patient group (LSM≥12.5 kPa) was divided according to risk of esophageal varices (LSM <25 kPa vs. LSM≥25 kPa). For all patients, each incremental unit in the natural logarithm (Ln) of LSM was associated with 14.76 times higher risk of developing LREs (p<0.001). Patients with cirrhosis (LSM≥12.5 kPa) had a higher risk of LREs than patients without cirrhosis (LSM<12.5 kPa) [adjusted hazard ratio (aHR) = 30.97; p<0.001]. When only cirrhotic patients were analyzed (n = 60), each incremental unit in the Ln of LSM was associated with 10.56 times higher risk of developing LREs (p = 0.010). Patients with LSM≥25 kPa had a greater risk for LRE development compared to those with LSM<25 kPa (aHR = 3.65; p = 0.045). The AUROC for predicting the onset of LREs was 0.876 in all patients and 0.729 in cirrhotic patients. In conclusion, LSM was associated with an increased risk of developing LREs in HCV-infected patients, even within the group of cirrhotic patients.
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Taibi L, Boyd A, Bosselut N, Bottero J, Guéchot J, Lacombe K, Lasnier E, Baudin B, Vaubourdolle M. Diagnostic accuracy of the Coopscore © to predict liver fibrosis in human immunodeficiency virus/hepatitis B virus co-infection. Ann Clin Biochem 2017; 55:236-243. [PMID: 28661201 DOI: 10.1177/0004563217707979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Non-invasive methods for assessing liver fibrosis are increasingly used as an alternative to liver biopsy. Recently, a score-based biochemical blood test (Coopscore©) was developed in a cohort of patients chronically infected with hepatitis C virus, showing higher diagnostic performances than Fibrometer®, Fibrotest®, Hepascore® and Fibroscan™. Here, we assess its performance in patients co-infected with the human immunodeficiency virus and hepatitis B virus. Methods Ninety-seven human immunodeficiency virus/hepatitis B virus co-infected patients with liver biopsies were included from a previously described cohort. Histological fibrosis staging using METAVIR criteria was used as the reference. Coopscore©, Fibrotest®, Fibrometer®, Hepascore® and Zeng score were computed and compared with the Coopscore© using the Obuchowski index and area under the receiving operator characteristic curves. Results The distribution of liver fibrosis levels was as follows: F0-F1 ( n = 42), F2 ( n = 25), F3 ( n = 15) and F4 ( n = 15). The Obuchowski index was higher for Coopscore© (0.774) than Fibrometer® (0.668), Hepascore® (0.690) and Zeng scores (0.704) ( P < 0.05), reflecting a better ability to discriminate between fibrosis stages. Similarly, when predicting significant fibrosis (≥F2), the AUROC was significantly greater for the Coopscore© (0.836) than the Hepascore® (0.727) and Zeng scores (0.746), but not for the Fibrotest® (0.778, P = 0.14) or Fibrometer® (0.790, P = 0.19). The Coopscore© did not show a higher capacity than other scores to predict advanced fibrosis (≥F3) or cirrhosis (F4). Conclusions This study supports the diagnostic value of the Coospcore© in fibrosis staging among human immunodeficiency virus/hepatitis B virus co-infected patients, especially to predict significant fibrosis.
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Affiliation(s)
- Ludmia Taibi
- 1 Pôle de Biologie Médicale et Pathologie, Hôpitaux Universitaire de l'Est Parisien, site Saint-Antoine, Paris, France
| | - Anders Boyd
- 2 INSERM, UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Nelly Bosselut
- 1 Pôle de Biologie Médicale et Pathologie, Hôpitaux Universitaire de l'Est Parisien, site Saint-Antoine, Paris, France.,3 INSERM, UMR-S 938, F-75012, Paris, France
| | - Julie Bottero
- 4 Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Jérôme Guéchot
- 1 Pôle de Biologie Médicale et Pathologie, Hôpitaux Universitaire de l'Est Parisien, site Saint-Antoine, Paris, France
| | - Karine Lacombe
- 2 INSERM, UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,5 Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, Paris, France
| | - Elisabeth Lasnier
- 1 Pôle de Biologie Médicale et Pathologie, Hôpitaux Universitaire de l'Est Parisien, site Saint-Antoine, Paris, France
| | - Bruno Baudin
- 1 Pôle de Biologie Médicale et Pathologie, Hôpitaux Universitaire de l'Est Parisien, site Saint-Antoine, Paris, France
| | - Michel Vaubourdolle
- 1 Pôle de Biologie Médicale et Pathologie, Hôpitaux Universitaire de l'Est Parisien, site Saint-Antoine, Paris, France
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Sulyok M, Ferenci T, Makara M, Horváth G, Szlávik J, Rupnik Z, Kormos L, Gerlei Z, Sulyok Z, Vályi-Nagy I. Hepatic fibrosis and factors associated with liver stiffness in HIV mono-infected individuals. PeerJ 2017; 5:e2867. [PMID: 28097068 PMCID: PMC5234436 DOI: 10.7717/peerj.2867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/06/2016] [Indexed: 12/30/2022] Open
Abstract
Background Liver disease has become an important cause of morbidity and mortality even in those HIV-infected individuals who are devoid of hepatitis virus co-infection. The aim of this study was to evaluate the degree of hepatic fibrosis and the role of associated factors using liver stiffness measurement in HIV mono-infected patients without significant alcohol intake. Methods We performed a cross-sectional study of 101 HIV mono-infected patients recruited prospectively from March 1, 2014 to October 30, 2014 at the Center for HIV, St István and St László Hospital, Budapest, Hungary. To determine hepatic fibrosis, liver stiffness was measured with transient elastography. Demographic, immunologic and other clinical parameters were collected to establish a multivariate model. Bayesian Model Averaging (BMA) was performed to identify predictors of liver stiffness. Results Liver stiffness ranged from 3.0–34.3 kPa, with a median value of 5.1 kPa (IQR 1.7). BMA provided a very high support for age (Posterior Effect Probability-PEP: 84.5%), moderate for BMI (PEP: 49.3%), CD4/8 ratio (PEP: 44.2%) and lipodystrophy (PEP: 44.0%). For all remaining variables, the model rather provides evidence against their effect. These results overall suggest that age and BMI have a positive association with LS, while CD4/8 ratio and lipodystrophy are negatively associated. Discussion Our findings shed light on the possible importance of ageing, overweight and HIV-induced immune dysregulation in the development of liver fibrosis in the HIV-infected population. Nonetheless, further controlled studies are warranted to clarify causal relations.
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Affiliation(s)
- Mihály Sulyok
- Doctoral School for Clinical Medicine, Semmelweis University, Budapest, Hungary; Institute for Tropical Medicine, Eberhard Karls University, Tuebingen, Germany
| | - Tamás Ferenci
- John von Neumann Faculty of Informatics, Physiological Controls Group, Óbuda University , Budapest , Hungary
| | - Mihály Makara
- Center for Hepatology, St. István and St László Hospital, Budapest, Hungary; Hepatology Center of Buda, Budapest, Hungary
| | | | - János Szlávik
- Center for HIV, St. István and St László Hospital , Budapest , Hungary
| | - Zsófia Rupnik
- Center for HIV, St. István and St László Hospital , Budapest , Hungary
| | - Luca Kormos
- Center for HIV, St. István and St László Hospital , Budapest , Hungary
| | - Zsuzsanna Gerlei
- Transplantation and Surgical Clinic, Semmelweis University , Budapest , Hungary
| | - Zita Sulyok
- Institute for Tropical Medicine, Eberhard Karls University , Tuebingen , Germany
| | - István Vályi-Nagy
- Center for Hepatology, St. István and St László Hospital, Budapest, Hungary; Center for HIV, St. István and St László Hospital, Budapest, Hungary
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Schwabl P, Mandorfer M, Steiner S, Scheiner B, Chromy D, Herac M, Bucsics T, Hayden H, Grabmeier-Pfistershammer K, Ferlitsch A, Oberhuber G, Trauner M, Peck-Radosavljevic M, Reiberger T. Interferon-free regimens improve portal hypertension and histological necroinflammation in HIV/HCV patients with advanced liver disease. Aliment Pharmacol Ther 2017; 45:139-149. [PMID: 27910154 DOI: 10.1111/apt.13844] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/09/2016] [Accepted: 10/05/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND HIV/HCV co-infected patients show accelerated fibrosis progression and higher risk for complications of portal hypertension (PHT). AIM To assess the effects of interferon-free therapy on portal pressure, liver histology and plasma biomarkers in HIV/HCV-coinfected patients with PHT. METHODS Twenty-two patients with paired hepatic venous pressure gradient (HVPG) measurements prior and after successful treatment (SVR) with interferon-free regimens were included. Liver stiffness was assessed by transient elastography and biopsies were scored according to METAVIR. Plasma biomarkers were determined by ELISA. RESULTS Overall, HVPG decreased from 10.7 ± 4.1 mmHg at baseline to 7.4 ± 4.2 mmHg after HCV treatment (Δ:-3.3 ± 2.7 mmHg; p < 0.001). In patients with clinically significant PHT (HVPG≥10 mmHg, n = 11), HVPG decreased from 14.1 ± 2.9 to 10.4 ± 3.9 mmHg (Δ:-3.7 ± 3.3 mmHg; p = 0.004) and a haemodynamic response (HVPG decrease ≥10%) was observed in 73%. In 64% of patients with subclinical PHT (HVPG 6-9 mmHg, n = 11), portal pressure normalised at SVR. Mean liver stiffness decreased from 20.8 kPa to 11.5 kPa (Δ:-8.8 ± 7.4 kPa; p < 0.001). Fifty percent (7/14) of patients with cirrhosis were re-classified as METAVIR ≤F3 and all patients with decompensated cirrhosis improved their Child-Pugh stage. After successful HCV treatment, 39% still had persistent histological necroinflammatory activity (METAVIR A1), which correlated with less HVPG response and more steatosis. While most biomarkers improved with SVR, METAVIR A1 patients had significantly higher plasma levels of fibrogenic (PDGF, TGF-β) and angiogenic (VEGF, Angiopoietin1) biomarkers. CONCLUSIONS Interferon-free therapy reduces PHT and halts histological necroinflammatory activity in the majority of HIV/HCV-coinfected patients after SVR, which may lead to re-compensation of liver function in cirrhosis. Biomarkers could identify patients with persisting hepatic necroinflammation.
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Affiliation(s)
- P Schwabl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - M Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - S Steiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - B Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - D Chromy
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - M Herac
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - T Bucsics
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - H Hayden
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - K Grabmeier-Pfistershammer
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.,Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - G Oberhuber
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - M Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - M Peck-Radosavljevic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - T Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
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Rey D, Muret P, Piroth L. Optimum combination therapy regimens for HIV/HCV infection. Expert Rev Anti Infect Ther 2016; 14:299-309. [PMID: 26822803 DOI: 10.1586/14787210.2016.1147952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIV-HCV co-infection mostly affects intravenous drug users, in whom prevalence has tended to decrease in recent years, while it has increased in men who have sex with men, with occurrence of acute hepatitis C. Hepatitis C has a poorer prognosis in patients co-infected with HIV, as clinical progression is faster and degree of hepatic fibrosis is greater. However, optimized ARV treatment is clearly associated with slower progression to hepatic complications. Interactions between HCV and HIV drugs are numerous, which underlines the importance of pharmacological advice for HIV-treated patients before they start HCV treatment. In HIV-HCV co-infection, treatment of hepatitis C has to be offered as in mono-infected patients (US and European countries) or to all patients (French guidelines). In most patients, HCV eradication is achieved with different DAA associations, the choice and duration being driven by HCV genotype, hepatic fibrosis stage, and whether patients have been previously treated or not.
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Affiliation(s)
- David Rey
- a Le Trait d'Union, Center for HIV Care, NHC , Hôpitaux Universitaires , Strasbourg , France
| | - Patrice Muret
- b Laboratoire de Pharmacologie Clinique , INSERM U1098 , CHRU Besançon , France
| | - Lionel Piroth
- c Infectious Diseases Department, Centre Hospitalier Universitaire and UMR 1347 , Université de Bourgogne , Dijon , France
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Pérez-Latorre L, Rivero-Juárez A, Hontañón V, Díez C, Cuenca F, Martín-Carbonero ML, Montes ML, Bellón JM, Aldámiz-Echevarría T, Carrero A, Rivero A, González-García J, Berenguer J. Prognostic Value of Transient Elastography in Human Immunodeficiency Virus-Infected Patients With Chronic Hepatitis C. Open Forum Infect Dis 2016; 3:ofw212. [PMID: 27833930 PMCID: PMC5102143 DOI: 10.1093/ofid/ofw212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/02/2016] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Leire Pérez-Latorre
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Antonio Rivero-Juárez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Spain
| | - Víctor Hontañón
- Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid, Spain
| | - Cristina Díez
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Francisca Cuenca
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Spain
| | - Maria Luz Martín-Carbonero
- Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid, Spain
| | - María L. Montes
- Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid, Spain
| | - José M. Bellón
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Teresa Aldámiz-Echevarría
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Ana Carrero
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Spain
| | - Juan González-García
- Unidad de VIH, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Universidad Autónoma de Madrid, Spain
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
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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. AIDS 2016; 30:723-9. [PMID: 26595542 DOI: 10.1097/qad.0000000000000975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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. DESIGN 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. CONCLUSION ELF predicted all-cause mortality and was superior to APRI and FIB-4 in HIV/HCV coinfected women.
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Conti CB, Cavalcoli F, Fraquelli M, Conte D, Massironi S. Ultrasound elastographic techniques in focal liver lesions. World J Gastroenterol 2016; 22:2647-56. [PMID: 26973405 PMCID: PMC4777989 DOI: 10.3748/wjg.v22.i9.2647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 12/23/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
Elastographic techniques are new ultrasound-based imaging techniques developed to estimate tissue deformability/stiffness. Several ultrasound elastographic approaches have been developed, such as static elastography, transient elastography and acoustic radiation force imaging methods, which include point shear wave and shear wave imaging elastography. The application of these methods in clinical practice aims at estimating the mechanical tissues properties. One of the main settings for the application of these tools has been liver stiffness assessment in chronic liver disease, which has been studied mainly using transient elastography. Another field of application for these techniques is the assessment of focal lesions, detected by ultrasound in organs such as pancreas, prostate, breast, thyroid, lymph nodes. Considering the frequency and importance of the detection of focal liver lesions through routine ultrasound, some studies have also aimed to assess the role that elestography can play in studying the stiffness of different types of liver lesions, in order to predict their nature and thus offer valuable non-invasive methods for the diagnosis of liver masses.
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12
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Merchante N, Téllez F, Rivero-Juárez A, Ríos-Villegas MJ, Merino D, Márquez-Solero M, Omar M, Recio E, Pérez-Pérez M, Camacho Á, Macías-Dorado S, Macías J, Lorenzo-Moncada S, Rivero A, Pineda JA. Progression of liver stiffness predicts clinical events in HIV/HCV-coinfected patients with compensated cirrhosis. BMC Infect Dis 2015; 15:557. [PMID: 26643257 PMCID: PMC4672550 DOI: 10.1186/s12879-015-1291-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/24/2015] [Indexed: 12/30/2022] Open
Abstract
Background Our objective was to assess the predictive value of the changes of liver stiffness (LS) for clinical outcome in HIV/HCV-coinfected patients with compensated liver cirrhosis and a LS value < 40 kPa. Methods Prospective cohort of 275 HIV/HCV-coinfected patients with cirrhosis, no previous liver decompensation (LD) and LS < 40 kPa. The time from diagnosis to LD and/or hepatocellular carcinoma (HCC) and the predictors of this outcome were evaluated. Significant progression of LS was defined as an increase ≥ 30 % over the baseline value at any time during the follow-up. Results After a median (Q1-Q3) follow-up of 32 (20–48) months, 19 (6.9 %, 95 % CI: 3.8 %–9.9 %) patients developed a first LD and/or HCC. At the end of the follow-up, 247 (90 %) patients had undergone a further LS examination. Of them, 77 (31 %) patients had a significant progression of LS. The mean (SD) survival time free of LD and/or HCC was 67 (3) and 77 (1) months in patients with or without significant progression of LS (p = 0.01). Significant progression of LS was an independent predictor of LD and/or HCC (Adjusted Hazard Ratio 4.63; 95 % confidence interval: 1.34–16.02; p = 0.015). Conclusions Significant progression of LS is associated with a higher risk of clinical events in HIV/HCV-coinfected patients with compensated cirrhosis and LS < 40 kPa.
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Affiliation(s)
- Nicolás Merchante
- Unidad Clínica de Enfermedades Infecciosas y Microbiología. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014, Sevilla, Spain.
| | - Francisco Téllez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología. Hospital de La Línea de la Concepción, AGS Campo de Gibraltar, Cádiz, Spain.
| | - Antonio Rivero-Juárez
- Unidad de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | | | - Dolores Merino
- Unidad de Gestión Clínica de Enfermedades Infecciosas. Complejo Hospitalario de Huelva, Huelva, Spain.
| | - Manuel Márquez-Solero
- Unidad de Gestión Clínica de Enfermedades Infecciosas. Hospital Virgen de la Victoria. Complejo Hospitalario de Málaga, Málaga, Spain.
| | - Mohamed Omar
- Unidad de Enfermedades Infecciosas. Complejo Hospitalario de Jaén, Jaén, Spain.
| | - Eva Recio
- Unidad Clínica de Enfermedades Infecciosas y Microbiología. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014, Sevilla, Spain.
| | - Montserrat Pérez-Pérez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología. Hospital de La Línea de la Concepción, AGS Campo de Gibraltar, Cádiz, Spain.
| | - Ángela Camacho
- Unidad de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Sara Macías-Dorado
- Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - Juan Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014, Sevilla, Spain.
| | - Sandra Lorenzo-Moncada
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología. Hospital de La Línea de la Concepción, AGS Campo de Gibraltar, Cádiz, Spain.
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Juan A Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014, Sevilla, Spain.
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Kuniholm MH, Leach T, Lunievicz J, Olivo N, Anastos K, Vazquez Y, Brennan-Ing M, Karpiak SE, Alao O, Nash D, Ernst J. Hepatitis C Direct Acting Antiviral Therapies in a New York City HIV/AIDS Special Needs Plan: Uptake and Barriers. AIDS Patient Care STDS 2015; 29:643-5. [PMID: 26669792 DOI: 10.1089/apc.2015.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Mark H. Kuniholm
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Mark Brennan-Ing
- ACRIA, New York, New York
- New York University College of Nursing, New York, New York
| | - Stephen E. Karpiak
- ACRIA, New York, New York
- New York University College of Nursing, New York, New York
| | | | - Denis Nash
- City University of New York School of Public Health, Hunter College Campus, New York, New York
| | - Jerome Ernst
- Amida Care, New York, New York
- ACRIA, New York, New York
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Berenguer J, Zamora FX, Aldámiz-Echevarría T, Von Wichmann MA, Crespo M, López-Aldeguer J, Carrero A, Montes M, Quereda C, Téllez MJ, Galindo MJ, Sanz J, Santos I, Guardiola JM, Barros C, Ortega E, Pulido F, Rubio R, Mallolas J, Tural C, Jusdado JJ, Pérez G, Díez C, Álvarez-Pellicer J, Esteban H, Bellón JM, González-García J, Miralles P, Cosín J, López J, Padilla B, Parras F, Carrero A, Aldamiz-Echevarría T, Tejerina F, Gutiérrez I, Ramírez M, Carretero S, Bellón J, Berenguer J, Alvarez-Pellicer J, Rodríguez E, Arribas J, Montes M, Bernardino I, Pascual J, Zamora F, Peña J, Arnalich F, Díaz M, González-García J, Bustinduy M, Iribarren J, Rodríguez-Arrondo F, Von-Wichmann M, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, López-Aldeguer J, Callau P, Miró J, Gatell J, Mallolas J, Ferrer A, Galindo M, Van den Eynde E, Pérez M, Ribera E, Crespo M, Vergas J, Téllez M, Casado J, Dronda F, Moreno A, Pérez-Elías M, Sanfrutos M, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condés E, Barros C, Sanz J, Santos I, Hernando A, Rodríguez V, Rubio R, Pulido F, Domingo P, Guardiola J, Ortiz L, Ortega E, Torres R, Cervero M, Jusdado J, Rodríguez-Zapata M, Pérez G, Gaspar G, Barquilla E, Ramírez M, Moyano B, Aznar E, Esteban H. Comparison of the Prognostic Value of Liver Biopsy and FIB-4 Index in Patients Coinfected With HIV and Hepatitis C Virus. Clin Infect Dis 2014; 60:950-8. [DOI: 10.1093/cid/ciu939] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Francisco X. Zamora
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | - Teresa Aldámiz-Echevarría
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | | | | | | | - Ana Carrero
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Marisa Montes
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | | | | | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares
| | | | | | | | | | - Federico Pulido
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | | | | | | | | | - Cristina Díez
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Julio Álvarez-Pellicer
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | - José M. Bellón
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Juan González-García
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
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Mazzocato S, Orsetti E, Gesuita R, Piraccini F, Drenaggi D, Barchiesi F. Comparison of liver fibrosis progression in HIV/HCV co-infected and HCV mono-infected patients by transient elastometry. ACTA ACUST UNITED AC 2014; 46:797-802. [PMID: 25244675 DOI: 10.3109/00365548.2014.952245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Monitoring of liver fibrosis (LF) is an essential tool for preventing liver-related complications in HIV/HCV co-infected patients. In this study, we compared LF progression by transient elastometry (TE) in 50 HIV/HCV co-infected and 115 HCV mono-infected patients followed in our institution between June 2006 and December 2011. Patients naive to interferon therapy and with at least two measurements of liver stiffness by TE were included. In all, 76% of HIV/HCV co-infected and 75% of HCV mono-infected patients remained in the same stage of LF over time. Conversely, 19% and 15% of HIV/HCV co-infected and HCV mono-infected subjects, respectively, had progression to advanced LF (≥ F3). Our study found a similar proportion of HIV/HCV co-infected and HCV mono-infected patients that developed an advanced LF during the follow-up time considered. Alcohol abuse was the only factor significantly associated with the progression as evidenced by multiple quantile regression analysis.
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Affiliation(s)
- Susanna Mazzocato
- From the Clinica di Malattie Infettive, Università Politecnica delle Marche , Ancona , Italy
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Labarga P, Fernandez-Montero JV, Barreiro P, Pinilla J, Vispo E, de Mendoza C, Plaza Z, Soriano V. Changes in liver fibrosis in HIV/HCV-coinfected patients following different outcomes with peginterferon plus ribavirin therapy. J Viral Hepat 2014; 21:475-9. [PMID: 24750394 DOI: 10.1111/jvh.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 09/08/2013] [Indexed: 12/15/2022]
Abstract
There is scarce information about the impact of antiviral treatment on subsequent progression of liver fibrosis in HIV-infected patients with chronic hepatitis C who experience different outcomes following peginterferon-ribavirin therapy. We conducted a retrospective study of a cohort of HIV/HCV-coinfected patients with longitudinal assessment of liver fibrosis using elastometry. Patients were split out into four groups according to the prior peginterferon-ribavirin response: sustained virological response (SVR), relapse (R), partial response (PR) and null response (NR). A group of untreated, coinfected patients was taken as control. Significant liver fibrosis progression (sLFP) was defined as a shift from baseline Metavir estimates ≤ F2 to F3-F4, or by >30% increase in liver stiffness in patients with baseline F3-F4. Conversely, significant liver fibrosis regression (sLFR) was defined as a shift from baseline Metavir estimates F3-F4 to ≤ F2, or by >30% reduction in liver stiffness in patients that kept on F3-F4. A total of 498 HIV/HCV-coinfected patients were examined. They were classified as follows: 138 (27.7%) SVR, 40 (8%) R, 61 (12.2%) PR, 71 (14.3%) NR and 188 (37.8%) naive. After a mean follow-up of 53.3 months, sLFP occurred less frequently in patients with SVR (7.2%) compared with R (25%; P = 0.002), PR (23%; P = 0.002), NR (29.6%; P < 0.001) and naïve (19.7%; P = 0.002). Conversely, sLFR was 26.1% in SVR compared with 10% in R (P = 0.03), 14.8% in PR (P = 0.06), 16.9% in NR (P = 0.07) and 10.6% in naïve (P < 0.001). Sustained clearance of serum HCV-RNA following a course of antiviral treatment is the major determinant of liver fibrosis regression in HIV/HCV-coinfected patients.
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Affiliation(s)
- P Labarga
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
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Abstract
HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS-related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared with HCV-monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct-acting antiviral agents in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.
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Fernández-Montero JV, Vispo E, Barreiro P, Sierra-Enguita R, de Mendoza C, Labarga P, Soriano V. Hepatitis delta is a major determinant of liver decompensation events and death in HIV-infected patients. Clin Infect Dis 2014; 58:1549-53. [PMID: 24633686 DOI: 10.1093/cid/ciu167] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coinfection with hepatitis viruses is common in individuals infected with human immunodeficiency virus (HIV) and has become a leading cause of complications and death in those receiving antiretroviral therapy (ART). METHODS We retrospectively examined the effect of coinfection with hepatitis B, C, and/or D viruses (HBV, HCV, HDV, respectively) on liver decompensation events (ascites, variceal bleeding, encephalopathy, and/or hepatocellular carcinoma) and liver-related mortality in HIV-positive patients on regular follow-up since the year 2004 at a reference HIV clinic in Madrid, Spain. RESULTS A total of 1147 HIV-infected patients (mean age, 42 years; 81% males; 46% intravenous drug users, 85.4% on ART) were analyzed. Mean follow-up was 81.2 ± 17.8 months. At baseline, 521 patients (45.4%) were HCV-antibody positive, 85 (7.4%) were hepatitis B surface antigen positive, and 17 (1.5%) were anti-HDV positive. A total of 233 HIV/HCV-coinfected patients received antiviral therapy for HCV, of whom 106 (45%) achieved sustained virologic response (SVR). Overall, 15 patients died of liver-related complications and 26 developed hepatic decompensation events. Taking as controls the 524 HIV-monoinfected patients, HDV coinfection (adjusted hazard ratio [AHR], 7.5; 95% confidence interval [CI], 1.84-30.8; P = .005) and baseline liver stiffness (AHR, 1.1; 95% CI, 1.07-1.13; P < .0001) were associated with a higher rate of liver-related morbidity and mortality. In contrast, SVR following hepatitis C therapy in HIV/HCV-coinfected patients was protective (AHR, 0.11; 95% CI, .01-.86; P = .03). CONCLUSIONS Hepatitis delta is associated with a high rate of death and liver decompensation events in HIV-infected patients on ART.
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Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA. Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11:1573-84.e1-2; quiz e88-9. [PMID: 23954643 PMCID: PMC3900882 DOI: 10.1016/j.cgh.2013.07.034] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Liver stiffness measurement (LSM), using elastography, can independently predict outcomes of patients with chronic liver diseases (CLDs). However, there is much variation in reporting and consistency of findings. We performed a systematic review and meta-analysis to evaluate the association between LSM and outcomes of patients with CLDs. METHODS We performed a systematic review of the literature, through February 2013, for studies that followed up patients with CLDs prospectively for at least 6 months and reported the association between baseline LSM and subsequent development of decompensated cirrhosis or hepatocellular carcinoma (HCC), as well as mortality. Summary relative risk (RR) estimates per unit of LSM and 95% confidence intervals (CIs) were estimated using the random effects model. RESULTS Our final analysis included 17 studies, reporting on 7058 patients with CLDs. Baseline LSM was associated significantly with risk of hepatic decompensation (6 studies; RR, 1.07; 95% CI, 1.03-1.11), HCC (9 studies; RR, 1.11; 95% CI, 1.05-1.18), death (5 studies; RR, 1.22; 95% CI, 1.05-1.43), or a composite of these outcomes (7 studies; RR, 1.32; 95% CI, 1.16-1.51). We observed considerable heterogeneity among studies-primarily in the magnitude of effect, rather than the direction of effect. This heterogeneity could not be explained by variations in study locations, etiologies and stages of CLD, techniques to measure liver stiffness, adjustment for covariates, or method of imputing relationship in the meta-analysis. CONCLUSIONS Based on a meta-analysis of cohort studies, the degree of liver stiffness is associated with risk of decompensated cirrhosis, HCC, and death in patients with CLDs. LSM therefore might be used in risk stratification.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Larissa L. Fujii
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Zhen Wang
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Sumeet K. Asrani
- Division of Hepatology, Baylor University Medical Center, Dallas, Texas
| | - Richard L. Ehman
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jayant A. Talwalkar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
Liver disease is currently one of the leading causes of hospitalization and death in HIV-positive individuals. Coinfection with the hepatitis C virus (HCV) is a major contributor to this trend. Besides hepatic damage, which is enhanced in the presence of HIV-associated immunosuppression, HCV may contribute to disease in coinfected individuals by potentiating immune activation and chronic inflammation, which ultimately account for an increased risk of cardiovascular events, kidney disease, and cancers in this population. Fortunately, hepatitis C therapeutics has entered a revolutionary era in which we hope that most patients treated with the new oral direct-acting antivirals (DAA) will be cured. However, many challenges preclude envisioning a prompt elimination of HCV from the coinfected population. Issues that should be addressed include the following: (1) rising incidence of acute hepatitis C in men who have sex with men, and expansion/recrudescence of injection drug use in some settings/regions; (2) adverse drug interactions between antiretrovirals and DAA; and (3) high cost of DAA, which may lead many to defer or fail to access appropriate therapy.
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Lens S, Forns X. Utilidad de la elastografía de transición tras la respuesta virológica en la hepatitis crónica por el virus de la hepatitisC. Enferm Infecc Microbiol Clin 2013; 31:421-3. [DOI: 10.1016/j.eimc.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
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