Liver stiffness prognostic for hepatic complications in HIV/HCV-coinfected patients on DAAs

  • Corma-Gómez A & al.
  • Clin Infect Dis
  • 22 Nov 2019

  • International Clinical Digest
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Takeaway

  • Liver stiffness (LS) at time of sustained virologic response (SVR) identifies risk of subsequent hepatic complications (hepatocellular carcinoma [HCC]), mortality in HIV/HCV-coinfected patients with advanced fibrosis receiving direct-acting antivirals (DAAs).

Why this matters

  • Consider LS to identify patients at SVR at lower risk for liver complications, for removal from HCC surveillance.

Key results

  • 640 patients.
  • 2.8% (18), 0.3% (2) patients developed hepatic complications, underwent liver transplant, respectively; 3.0% (19) reached primary endpoint after median follow-up of 10.2 (range, 5.6-16.8) months.
  • Multivariate, predictors of liver complications, transplant:
    • Pretreatment Model for End-Stage Liver Disease scores >10 (subhazard ratio [SHR], 1.37; P=.031).
    • Child-Pugh-Turcotte (CPT) score B or C (SHR, 62.5; P=.007).
    • Prior liver decompensation (SHR, 3.42; P=.014).
    • CPT at SVR (SHR, 10.71; P=.027).
    • CD4 cell count
    • Fibrosis-4 score index at SVR (SHR, 1.39; P=.002), LS at SVR (SHR, 1.05; P=.002).
  • No patient with LS

Study design

  • Prospective analysis of predictive ability of VCTE-measured LS at time of SVR for liver complications in HIV/HCV-coinfected Spanish patients with advanced liver fibrosis or cirrhosis.
  • Funding: Instituto de Salud Carlos III.

Limitations

  • Limited generalisability.
  • Insufficient follow-up duration.