TE superior to FIB-4 for diagnosing HIV/HCV coinfection outcomes
BOSTON — The use of transient elastography was superior in predicting clinical outcomes, such as decompensation and hepatocellular carcinoma, for patients with HIV/hepatitis C virus infection coinfection compared with Fibrosis-4, according to research presented at CROI 2016.
Researchers evaluated data for 1,159 patients with HIV/HCV coinfection who underwent transient elastography (TE) and Fibrosis-4 (FIB-4) testing between September 2003 and January 2015. Each patient had at least one determination of liver stiffness, coinfection and compensated chronic HCV.
The primary outcome was to determine liver decompensation or hepatocellular carcinoma (HCC), among other liver-related events, and area under the receiving operating curve (AUROC) analyses were used to determine the abilities of TE and FIB-4 to predict these outcomes. In addition, researchers measured any association between advanced fibrosis —TE (greater than 9.5) or FIB-4 (greater than 3.25) — and decompensation or HCC through multivariate Cox regression analysis.
Over a median follow-up of 5.8 years, 65 patients died, 67 developed liver decompensation and 17 developed HCC.
Baseline fibrosis determined by TE was less than 7.1 in 539 patients, greater than 7.1 and less than 9.5 in 182 patients and greater than 9.5 in 438 patients. Fibrosis determined by FIB-4 was less than 1 in 453 patients, greater than 1 and less than 3.25 in 520 patients and greater than 3.25 in 186 patients.
The AUROCs by TE for decompensation and HCC was 0.854 (0.805–0.902), and 0.670 (0.595–0.743) by FIB-4 (P ≤ .001). The AUROCs for overall mortality and development of decompensation or HCC were all higher for TE than for FIB-4. The adjusted hazard ratio for developing decompensation or HCC was 18.7 (95% CI, 9.00-38.7) for advanced fibrosis by TE and 5.36 (95% CI, 3.22-8.93) for advanced fibrosis by FIB-4 (P < .001 for both).
The researchers concluded: “TE outperformed FIB-4 as a predictor of clinical outcomes. These findings support the prognostic role of TE in patients with HIV/HCV coinfection.” – by Melinda Stevens
Díez C, et al. Abstract #527. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.
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