Liver stiffness and aspartate aminotransferase levels predict the risk for liver fibrosis progression in hepatitis C virus/HIV-coinfected patients

HIV Med. 2015 Apr;16(4):211-8. doi: 10.1111/hiv.12197. Epub 2014 Sep 18.

Abstract

Objectives: The aim of the study was to investigate liver fibrosis outcome and the risk factors associated with liver fibrosis progression in hepatitis C virus (HCV)/HIV-coinfected patients.

Methods: We prospectively obtained liver stiffness measurements by transient elastography in a cohort of 154 HCV/HIV-coinfected patients, mostly Caucasian men on suppressive antiretroviral treatment, with the aim of determining the risk for liver stiffness measurement (LSM) increase and to identify the predictive factors for liver fibrosis progression. To evaluate LSM trends over time, a linear mixed regression model with LSM level as the outcome and duration of follow-up in years as the main covariate was fitted.

Results: After a median follow-up time of 40 months, the median increase in LSM was 1.05 kPa/year [95% confidence interval (CI) 0.72-1.38 kPa/year]. Fibrosis stage progression was seen in 47% of patients, and 17% progressed to cirrhosis. Aspartate aminotransferase (AST) levels and liver fibrosis stage at baseline were identified as independent predictors of LSM change. Patients with F3 (LSM 9.6-14.5 kPa) or AST levels ≥ 64 IU/L at baseline were at higher risk for accelerated LSM increase (ranging from 1.45 to 2.61 kPa/year), whereas LSM change was very slow among patients with both F0-F1 (LSM ≤ 7.5 kPa) and AST levels ≤ 64 IU/L at baseline (0.34 to 0.58 kPa/year). An intermediate risk for LSM increase (from 0.78 to 1.03 kPa/year) was seen in patients with F2 (LSM 7.6-9.5 kPa) and AST baseline levels ≤ 64 IU/L.

Conclusions: AST levels and liver stiffness at baseline allow stratification of the risk for fibrosis progression and might be clinically useful to guide HCV treatment decisions in HIV-infected patients.

Keywords: HIV coinfection; hepatitis C virus; liver fibrosis; liver stiffness; transient elastography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / adverse effects
  • Aspartate Aminotransferases / metabolism*
  • Coinfection / complications
  • Disease Progression
  • Elasticity Imaging Techniques / methods*
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / pathology
  • HIV Protease Inhibitors / adverse effects
  • Hepatitis C / complications*
  • Hepatitis C / drug therapy
  • Hepatitis C / pathology
  • Humans
  • Liver / metabolism
  • Liver / pathology*
  • Liver Cirrhosis / chemically induced*
  • Liver Cirrhosis / pathology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Spain / epidemiology

Substances

  • Anti-HIV Agents
  • HIV Protease Inhibitors
  • Aspartate Aminotransferases