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Liver stiffness measurement versus liver biopsy to predict survival and decompensations of cirrhosis among HIV/hepatitis C virus-coinfected patients

Macías, Juana; Camacho, Angelab; Von Wichmann, Miguel A.c; López-Cortés, Luis F.d; Ortega, Enriquee; Tural, Cristinaf; Ríos, Maria J.g; Merino, Doloresh; Téllez, Franciscoi; Márquez, Manuelj; Mancebo, Maríaa; Pineda, Juan A.a

doi: 10.1097/QAD.0b013e32836381f3
Clinical Science

Objective: To compare the prognostic performance of liver biopsy with that of liver stiffness measurement (LSM) to predict survival and liver decompensations among HIV/hepatitis C virus (HCV)-coinfected patients.

Design: Retrospective cohort study.

Methods: Cohort of 297 HIV/HCV-coinfected patients, who underwent a liver biopsy and LSM separated by 12 months or less, followed in 10 Spanish tertiary care centers from December 2005 to December 2011 (median follow-up, 5 years; interquartile range, 4.2–5.4 years). Liver biopsies were staged following the Scheuer's score. LSM was obtained by hepatic transient elastometry. A survival analysis was carried out and the integrated discrimination improvement was computed to compare the ability of the survival models to predict outcomes. The incidence of death from any cause and of development of the first decompensation of cirrhosis was calculated.

Results: Overall mortality rate was 1.63 [95% confidence interval (CI) 1.06–2.49] per 100 person-years. The adjusted hazard ratio [AHR (95% CI)] of baseline fibrosis (per stage of fibrosis) was 1.52 (1.08–2.15, P = 0.017) and of LSM (per 5 kPa increase) 1.28 (1.12–1.46, P < 0.001). LSM including models yielded a performance 3.9% better than the liver biopsy-based models (P = 0.072). For the prediction of liver decompensations, the AHR (95% CI) of baseline fibrosis by liver biopsy (per stage of fibrosis) was 1.67 (1.15–2.43, P = 0.007) and of LSM (per 5 kPa increase) 1.37 (1.21–1.54, P < 0.001). LSM-based models yielded a performance 8.4% better than the liver biopsy-based models (P = 0.045).

Conclusion: LSM-based prediction achieves a similar yield than liver biopsy-based models to predict overall mortality in HIV/HCV-coinfected patients. Models including LSM could predict better liver decompensations than liver biopsy.

aInfectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla, Seville

bInfectious Diseases Unit, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Cordoba

cInfectious Diseases Unit, Hospital Donostia, San Sebastian

dInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville

eInfectious Diseases Unit, Hospital General Universitario de Valencia, Valencia

fInternal Medicine Service, FundacióLluita Contra la SIDA, University Hospital GermansTrias I Pujol, UniversitatAutònoma de Barcelona, Barcelona

gInfectious Diseases Unit, Hospital Universitario Virgen Macarena, Seville

hInfectious Diseases Unit, Complejo Hospitalario de Huelva, Huelva

iInfectious Diseases Unit, Hospital de La Línea de la Concepción, Cadiz

jInfectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain.

Correspondence to Dr Juan A. Pineda, Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda. Bellavista s/n, 41014-Seville, Spain. Tel: +34 955 015864; fax: +34 955 015757; e-mail:

Received 26 March, 2013

Revised 20 May, 2013

Accepted 21 May, 2013

© 2013 Lippincott Williams & Wilkins, Inc.