Change in fibrosis score as a predictor of mortality among HIV-infected patients with viral hepatitis

AIDS Patient Care STDS. 2012 Feb;26(2):73-80. doi: 10.1089/apc.2011.0191. Epub 2012 Jan 12.

Abstract

Noninvasive markers of liver fibrosis, measured at baseline, have been shown to predict liver-related mortality. It remains unknown if a change in the value of the scores over time predicts mortality in patients with HIV and viral hepatitis. In this retrospective study, survival in HIV/hepatitis B virus (HBV; n = 67), HIV/hepatitis C virus (HCV; n = 43), and HIV/HBV/HCV (n = 41) patients was examined using Kaplan-Meier life table analysis. Aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and FIB-4 scores, two noninvasive markers of liver fibrosis, were calculated at baseline and at last available clinical follow-up to determine the change in fibrosis score. Factors associated with mortality were assessed by Cox proportional hazards, including the change in the noninvasive marker score between the two time points. All-cause mortality was determined by Social Security Death Index and chart review. Sixty-seven were coinfected with HIV/HBV, 43 with HIV/HCV, and 41 were triply infected (HIV/HBV/HCV). Kaplan-Meier analysis showed similar survival for the three groups at 7 years of follow-up (p = 0.10). However, median length of follow-up was lower in HIV/HCV (60.5; range 0-102) compared to HIV/HBV (75.7; 12.3-126.5) and HIV/HBV/HCV (80.0; 2.7-123) months, respectively, p = 0.02. Baseline fibrosis score (p = 0.002), an increase in the value for noninvasive measurements for fibrosis (p < 0.001), and the presence of HIV/HCV coinfection (p = 0.041) were each associated with higher risk for mortality. Baseline fibrosis score (p = 0.03) and an increase in FIB-4 score (p = 0.05) were independent predictors of all-cause mortality, but liver-related mortality was not evaluated. In this study, baseline fibrosis score was predictive of 7-year all-cause mortality. Further studies are needed in a prospective cohort to evaluate the predictive value of monitoring changes in fibrosis scores over time to predict mortality in patients with viral hepatitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / enzymology
  • Acquired Immunodeficiency Syndrome / mortality
  • Acquired Immunodeficiency Syndrome / pathology*
  • Adult
  • Alanine Transaminase / blood*
  • Aspartate Aminotransferases / blood*
  • Biomarkers / blood
  • Cohort Studies
  • Coinfection
  • Female
  • Follow-Up Studies
  • Hepatitis B / enzymology
  • Hepatitis B / mortality
  • Hepatitis B / pathology*
  • Hepatitis C / enzymology
  • Hepatitis C / mortality
  • Hepatitis C / pathology*
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / enzymology
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / pathology*
  • Male
  • Middle Aged
  • Platelet Count
  • Predictive Value of Tests
  • Survival Analysis
  • Young Adult

Substances

  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase