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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

Mathieu Chalouni 1, 2 Philippe Sogni 3 Patrick Miailhes 4 Karine Lacombe 5, 6 Isabelle Poizot-Martin 7 Julie Chas 8 Daniel Vittecoq 9 Didier Neau 10 Hugues Aumaitre 11 Laurent Alric 12 Lionel Piroth 13 Olivier Bouchaud 14 Christine Katlama 15 Philippe Morlat 16 Caroline Lascoux-Combe 17 Anne Gervais 18 Alissa Naqvi 19 Eric Rosenthal 20 Daniel Garipuy 21 Karl Barange 22 Laure Esterle 1, 2 Dominique Salmon 23 Linda Wittkop 1, 2
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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Submitted on : Tuesday, May 19, 2020 - 7:11:38 PM
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Mathieu Chalouni, Philippe Sogni, Patrick Miailhes, Karine Lacombe, Isabelle Poizot-Martin, et al.. 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. European Journal of Gastroenterology and Hepatology, Lippincott, Williams & Wilkins, 2019, 31 (11), pp.1387-1396. ⟨10.1097/MEG.0000000000001408⟩. ⟨hal-02613148⟩

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