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Piselli P, Serraino D, Fusco M, Girardi E, Pirozzi A, Toffolutti F, Cimaglia C, Taborelli M. Hepatitis C virus infection and risk of liver-related and non-liver-related deaths: a population-based cohort study in Naples, southern Italy. BMC Infect Dis 2021; 21:667. [PMID: 34238231 PMCID: PMC8268172 DOI: 10.1186/s12879-021-06336-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. This study aimed to evaluate the impact of HCV infection on all-cause, liver-related, and non-liver-related mortality in a population living in an area with a high prevalence of HCV infection before the advent of Direct-Acting Antiviral (DAA) therapies, and to identify factors associated with cause-specific mortality among HCV-infected individuals. Methods We conducted a cohort study on 4492 individuals enrolled between 2003 and 2006 in a population-based seroprevalence survey on viral hepatitis infections in the province of Naples, southern Italy. Study participants provided serum for antibodies to HCV (anti-HCV) and HCV RNA testing. Information on vital status to December 2017 and cause of death were retrieved through record-linkage with the mortality database. Hazard ratios (HRs) for cause-specific mortality and 95% confidence intervals (CIs) were estimated using Fine-Grey regression models. Results Out of 626 deceased people, 20 (3.2%) died from non-natural causes, 56 (8.9%) from liver-related conditions, 550 (87.9%) from non-liver-related causes. Anti-HCV positive people were at higher risk of death from all causes (HR = 1.38, 95% CI: 1.12–1.70) and liver-related causes (HR = 5.90, 95% CI: 3.00–11.59) than anti-HCV negative ones. Individuals with chronic HCV infection reported an elevated risk of death due to liver-related conditions (HR = 6.61, 95% CI: 3.29–13.27) and to any cause (HR = 1.51, 95% CI: 1.18–1.94). The death risk of anti-HCV seropositive people with negative HCV RNA was similar to that of anti-HCV seronegative ones. Among anti-HCV positive people, liver-related mortality was associated with a high FIB-4 index score (HR = 39.96, 95% CI: 4.73–337.54). Conclusions These findings show the detrimental impact of HCV infection on all-cause mortality and, particularly, liver-related mortality. This effect emerged among individuals with chronic infection while those with cleared infection had the same risk of uninfected ones. These results underline the need to identify through screening all people with chronic HCV infection notably in areas with a high prevalence of HCV infection, and promptly provide them with DAAs treatment to achieve progressive HCV elimination and reduce HCV-related mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06336-9.
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Affiliation(s)
- Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - Mario Fusco
- Registro Tumori, ASL Napoli-3 Sud, Brusciano, Naples, Italy
| | - Enrico Girardi
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Angelo Pirozzi
- Registro Tumori, ASL Napoli-3 Sud, Brusciano, Naples, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, PN, Italy.
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Saleem N, Miller LS, Dadabhai AS, Cartwright EJ. Using vibration controlled transient elastography and FIB-4 to assess liver cirrhosis in a hepatitis C virus infected population. Medicine (Baltimore) 2021; 100:e26200. [PMID: 34115003 PMCID: PMC8202644 DOI: 10.1097/md.0000000000026200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/12/2021] [Indexed: 01/04/2023] Open
Abstract
We assessed the performance characteristics of the Fibrosis-4 (FIB-4) score in a veteran population with chronic hepatitis C virus (HCV) infection and used vibration controlled transient elastography (VCTE) as the gold standard.All VCTE studies were performed by a single operator on United States veterans with HCV infection presenting for care at the Atlanta VA Medical Center (AVAMC) over a 2 year period. VCTE liver stiffness measurements (LSM) were categorized as cirrhotic if LSM was >12.5 kPa and non-cirrhotic if LSM was ≤12.5 kPa. FIB-4 scores ≤3.25 were considered non-cirrhotic and scores >3.25 were considered cirrhotic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the FIB-4 score. A second analysis was done which identified and excluded indeterminate FIB-4 scores, defined as any value between 1.45 and 3.25.When FIB-4 was used to screen for liver cirrhosis using VCTE as the gold standard, sensitivity was 42%, specificity was 88%, PPV was 62%, and NPV was 76%. When indeterminate FIB-4 scores were excluded from the analysis, sensitivity was 95%, specificity was 61%, PPV was 62%, and NPV was 94.4%. In a veteran population with chronic HCV infection, we found the sensitivity of the FIB-4 score to be unacceptably low for ruling out liver cirrhosis when using a binary cutoff at 3.25. Using a second staging method like VCTE may be an effective way to screen for liver cirrhosis in persons with chronic HCV, especially when the FIB-4 score is in the indeterminate range.
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Affiliation(s)
| | | | | | - Emily J. Cartwright
- Emory University School of Medicine, Atlanta
- Atlanta VA Medical Center, Decatur, GA
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Chen X, Liu X, Tang R, Ye R, Yang Y, Yao S, Wang J, Ding Y, Duan S, He N. Fibrosis-4 index predicts mortality in HIV/HCV co-infected patients receiving combination antiretroviral therapy in rural China. Biosci Trends 2019; 13:32-39. [DOI: 10.5582/bst.2018.01299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Xiaochen Chen
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Renhai Tang
- Dehong Prefecture Center for Disease Control and Prevention
| | - Runhua Ye
- Dehong Prefecture Center for Disease Control and Prevention
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention
| | - Shitang Yao
- Dehong Prefecture Center for Disease Control and Prevention
| | - Jibao Wang
- Dehong Prefecture Center for Disease Control and Prevention
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
| | - Song Duan
- Dehong Prefecture Center for Disease Control and Prevention
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
- Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University
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Utility of FIB4-T as a Prognostic Factor for Hepatocellular Carcinoma. Cancers (Basel) 2019; 11:cancers11020203. [PMID: 30744175 PMCID: PMC6406758 DOI: 10.3390/cancers11020203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Most integrated scores for predicting the prognosis of patients with hepatocellular carcinoma (HCC) comprise tumor progression factors and liver function variables. The FIB4 index is an indicator of hepatic fibrosis calculated on the basis of age, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, and platelet count, but it does not include variables directly related to liver function. We propose a new staging system, referred to as “FIB4-T,” comprising the FIB4 index as well as tumor progression factors, and examine its usefulness. Method: Subjects included 3800 cases of HCC registered in multiple research centers. We defined grades 1, 2, and 3 as a Fibrosis-4 (FIB4) index of <3.25, 3.26–6.70, and >6.70 as FIB4, respectively, and calculated the FIB4-T in the same manner in which the JIS (Japan Integrated Staging Score) scores and albumin-bilirubin tumor node metastasis (ALBI-T) were calculated. We compared the prognostic prediction ability of FIB4-T with that of the JIS score and ALBI-T. Results: Mean observation period was 37 months. The 5-year survival rates (%) of JIS score (0/1/2/3/4/5), ALBI-T (0/1/2/3/4/5) and FIB4-T (0/1/2/3/4/5) were 74/60/36/16/0, 82/66/45/22/5/0 and 88/75/65/58/32/10, respectively. Comparisons of the Akaike information criteria among JIS scores, ALBI-T, and FIB4-T indicated that stratification using the FIB4-T system was comparable to those using ALBI-T and JIS score. The risk of mortality significantly increased (1.3–2.8 times/step) with an increase in FIB4-T, and clear stratification was possible regardless of the treatment. Conclusions: FIB4-T is useful in predicting the prognosis of patients with HCC from a new perspective.
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Kim HN, Crane HM, Rodriguez CV, Van Rompaey S, Mayer KH, Christopoulos K, Napravnik S, Chander G, Hutton H, McCaul ME, Cachay ER, Mugavero MJ, Moore R, Geng E, Eron JJ, Saag MS, Merrill JO, Kitahata MM. The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals. AIDS Behav 2017; 21:1878-1884. [PMID: 28035496 DOI: 10.1007/s10461-016-1665-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We examined risk factors for advanced hepatic fibrosis [fibrosis-4 (FIB)-4 >3.25] including both current alcohol use and a diagnosis of alcohol use disorder among HIV-infected patients. Of the 12,849 patients in our study, 2133 (17%) reported current hazardous drinking by AUDIT-C, 2321 (18%) had a diagnosis of alcohol use disorder, 2376 (18%) were co-infected with chronic hepatitis C virus (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (adjusted odds ratio (aOR) 6.3, 95% confidence interval (CI) 5.2-7.5), chronic hepatitis B (aOR 2.0, 95% CI 1.5-2.8), diabetes (aOR 2.3, 95% CI 1.8-2.9), current CD4 <200 cells/mm3 (aOR 5.4, 95% CI 4.2-6.9) and HIV RNA >500 copies/mL (aOR 1.3, 95% CI 1.0-1.6) were significantly associated with advanced fibrosis. A diagnosis of an alcohol use disorder (aOR 1.9, 95% CI 1.6-2.3) rather than report of current hazardous alcohol use was associated with high FIB-4. However, among HIV/HCV coinfected patients, both current hazardous drinkers (aOR 1.6, 95% CI 1.1-2.4) and current non-drinkers (aOR 1.6, 95% CI 1.2-2.0) were more likely than non-hazardous drinkers to have high FIB-4, with the latter potentially reflecting the impact of sick abstainers. These findings highlight the importance of using a longitudinal measure of alcohol exposure when evaluating the impact of alcohol on liver disease and associated outcomes.
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Braconnier P, Delforge M, Garjau M, Wissing KM, De Wit S. Hyponatremia is a marker of disease severity in HIV-infected patients: a retrospective cohort study. BMC Infect Dis 2017; 17:98. [PMID: 28122494 PMCID: PMC5267411 DOI: 10.1186/s12879-017-2191-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 01/05/2017] [Indexed: 12/19/2022] Open
Abstract
Background Hyponatremia is a frequent electrolyte disorder in HIV-infected patients with a prevalence of up to 56% in the pre-cART era. Several studies have demonstrated that patients with hyponatremia are at an increased risk of death. We aimed to investigate the prevalence of hyponatremia in the recent cART-era and evaluate its association with mortality. Methods Single-center retrospective cohort study. A total of 1196 newly diagnosed and cART-naïve HIV patients followed at the AIDS Reference Center, St Pierre University Hospital in Brussels, Belgium, between 1 January 1998 and 31 December 2013 were included. Hyponatremia was defined as a baseline natremia lower than 135 mmol/l. The outcome of interest was the occurrence of death. Results In this study 177 (14.8%) patients had hyponatremia at baseline with a median natremia of 132.0 mmol/l [interquartile range (IQR) 130.0-134.0 mmol/l]. Hyponatremic patients had a lower CD4 cell count (207.5 ± 197.7/μl vs 400.4 ± 277.0/μl; P < 0.0001) and a higher prevalence of AIDS (50.3% vs 12.4%; P < 0.0001) compared to normonatremic patients. A significantly higher proportion of patients with hyponatremia were hospitalized at first contact (72.3% vs 20.0%; P < 0.0001). During the follow-up hyponatremic patients had a shorter median time to a first hospitalization (2.0 IQR [0.0-12.0] months vs 13.0 IQR [2.0-29.0] months; P = 0.001) and an increased incident hospitalization rate (785/1000 patient-years, 95% CI 725–845 vs 370/1000 patient-years, 95% CI 352–388; P < 0.0001]. The incident mortality rate was 28.3/1000 patient-years (95% CI 18.15-42.16) in patients with hyponatremia compared to 9.33/1000 patient-years (95% CI 6.63-12.75) in normonatremic patients (P < 0.0001). Three-year cumulative survival rates were 85.8% ± 3.0% in hyponatremic patients and 96.3% ± 0.7% in normonatremic patients (log-rank P < 0.0001). However, in a multivariate Cox model adjusting for other risk factors such as AIDS, CD4 count < 350/μl and hepatitis C, hyponatremia was no longer a predictor for patient death (hazard ratio: 1.03, 95% CI 0.54-1.97; P = 0.935). Conclusions Hyponatremia is a marker of severity of HIV-disease but not an independent risk factor for mortality. HIV-patients with a low serum sodium at baseline might benefit from a close follow-up to improve outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2191-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philippe Braconnier
- Department of Infectious Diseases, AIDS Reference Center, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium. .,Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Marc Delforge
- Department of Infectious Diseases, AIDS Reference Center, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Garjau
- Department of Infectious Diseases, AIDS Reference Center, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Nephrology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Karl Martin Wissing
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Nephrology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, AIDS Reference Center, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Focà E, Fabbiani M, Prosperi M, Quiros Roldan E, Castelli F, Maggiolo F, Di Filippo E, Di Giambenedetto S, Gagliardini R, Saracino A, Di Pietro M, Gori A, Sighinolfi L, Pan A, Postorino MC, Torti C. Liver fibrosis progression and clinical outcomes are intertwined: role of CD4+ T-cell count and NRTI exposure from a large cohort of HIV/HCV-coinfected patients with detectable HCV-RNA: A MASTER cohort study. Medicine (Baltimore) 2016; 95:e4091. [PMID: 27442636 PMCID: PMC5265753 DOI: 10.1097/md.0000000000004091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) suffer from faster progression of liver fibrosis (LF) and have greater risk of worse clinical outcomes. We evaluated predictors and incidence of these events in a large multicentre cohort. METHODS We selected all HIV-infected patients starting a first-line combination antiretroviral therapy (cART), with detectable HCV-RNA, without exposure to interferon/ribavirin, with ≥2 fibrosis-4 index (FIB-4) classifications before cART. Kaplan-Meier analysis was used to estimate incidence of clinical events (AIDS, non-AIDS related, deaths) and LF progression (via transitions: from FIB-4 class 1 to 2 or 3, from class 2 to class 3, and worsening by 0.5 point). Multivariate Cox regression was used to assess predictors, baseline, or time updated. RESULTS One thousand four hundred thirty-three patients were selected. Overall, 745 clinical events occurred, with an incidence of 7.6% over 9811 person-year of follow-up (PYFU) and a median survival time of 9.36 years. Incidence of LF progression from FIB-4 class 1 to 2 or 3 was 12.4%, and from FIB-4 class 2 to 3 was 7% with a median survival time of 5.67 and 10.35 years, respectively. At multivariate analyses, intravenous drug use and time-updated gamma-glutamyl transferase (γGT) were negative predictors for any outcomes, either clinical or FIB-4 progression. Higher CD4+ T-cell protected from clinical events, and lower HIV-RNA and higher CD4+ T-cell appeared to protect from FIB-4 transitions. Moreover, independently from the viro-immunological status, current FIB-4 class 3 predicted clinical events. Occurrence of AIDS and cardiovascular/kidney events were significant predictors of 0.5 point worsening and transitions of FIB-4, respectively. Prolonged exposure to nucleos(t)ide reverse transcriptase inhibitors (NRTI) was a negative predictor for any outcomes. CONCLUSION Both clinical and LF progression in HIV/HCV-coinfected patients depend strongly on immune status. Intravenous drug users and patients with high γGT (a possible proxy for alcohol abuse) are most-at-risk for both outcomes, as well those who had prolonged exposures to the NRTI class. Therefore, these patients should be prioritized for the access to anti-HCV therapy and a test-and-treat strategy should be implemented for early initiation of cART. Possible benefits of NRTI sparing regimens in HIV/HCV-coinfected patients should be investigated.
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Affiliation(s)
- Emanuele Focà
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia
- Correspondence: Emanuele Focà, University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Piazzale Spedali Civili, 1, I-25123 Brescia, Italy (e-mail: )
| | | | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL
| | - Eugenia Quiros Roldan
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia
| | - Franco Maggiolo
- Clinic of Infectious Diseases of “Papa Giovanni XXIII” Hospital, Bergamo
| | - Elisa Di Filippo
- Clinic of Infectious Diseases of “Papa Giovanni XXIII” Hospital, Bergamo
| | | | - Roberta Gagliardini
- Institute of Clinical Infectious Diseases of Catholic University of Sacred Heart, Rome
| | | | - Massimo Di Pietro
- Clinic of Infectious Diseases of “Azienda Ospedaliera SM. Annunziata”, Firenze
| | - Andrea Gori
- Clinic of Infectious Diseases, “San Gerardo de’ Tintori” Hospital, Monza, Italy
| | - Laura Sighinolfi
- Clinic of Infectious Diseases of “Azienda Ospedaliera S. Anna”, Ferrara
| | - Angelo Pan
- Clinic of Infectious Diseases of “Istituti Ospitalieri”, Cremona
| | | | - Carlo Torti
- Infectious Diseases Unit, University “Magna Graecia”, Catanzaro, Italy
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