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Liver stiffness predicts liver-related complications and mortality in HIV patients with chronic hepatitis C on antiretroviral therapy

Fernández-Montero, José Vicente; Barreiro, Pablo; Vispo, Eugenia; Labarga, Pablo; Sánchez-Parra, Clara; Soriano, Vicente

doi: 10.1097/QAD.0b013e32835e063f
Clinical Science

Background: Liver disease is currently one of the leading causes of death in HIV individuals. Hepatic fibrosis largely mediates this effect and infection with hepatitis C virus (HCV) is the most common cause. Few studies have examined so far the predictive value of liver fibrosis staging on mortality and liver decompensation in HIV/HCV-coinfected patients.

Methods: A prospective programme of liver fibrosis assessment using transient elastometry has been ongoing at our institution since 2004. Data from all HIV/HCV-coinfected patients who underwent a transient elastometry examination and have at least 18 months of follow-up were selected for the current analysis.

Results: A total of 545 HIV/HCV-coinfected patients were examined (mean age 41 years, 71% men, 81% IDUs, mean BMI 23.3 kg/m2, HBsAg+ 4.2%, alcohol abuse 8.4%, mean CD4 cell count 519 cells/μl). The mean follow-up was 70.9 ± 15.7 months. During follow-up, 12 patients (2.2%) died, four of them due to hepatic complications. Liver-related events (ascites, encephalopathy, oesophageal varices or hepatocellular carcinoma) appeared in 53 patients (10%). In the multivariate analysis, baseline liver stiffness was the strongest predictor of liver-related complications [odds ratio (OR) 1.12, 95% confidence interval (CI) 1.08–1.16, P < 0.0001] and of all-cause mortality (OR 1.09, 95% CI 1.01–1.19, P = 0.02). The achievement of sustained virological response following peginterferon/ribavirin therapy during the study period was protective against the development of liver-related events (OR 0.02, 95% CI 0–0.23, P = 0.01).

Conclusion: Liver fibrosis staging, as measured by transient elastometry, predicts liver-related complications and all-cause mortality in HIV/HCV-coinfected patients on antiretroviral therapy.

Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.

Correspondence to Dr José Vicente Fernández-Montero, Department of Infectious Diseases, Hospital Carlos III. C/ Sinesio Delgado 10, Madrid 28029, Spain. Tel: +34 91 4532536; fax: +34 91 7336614; e-mail:

Received 6 November, 2012

Revised 11 December, 2012

Accepted 17 December, 2012

© 2013 Lippincott Williams & Wilkins, Inc.