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Increased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study.


ABSTRACT: BACKGROUND:The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study. METHODS:HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ?1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates. RESULTS:1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4-49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2-6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM ?12.5 kPa and 10.8% for patients with LSM >12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p<0.0001), history of HCV treatment (aHR = 0.53 [0.32; 0.90], p = 0.01) and smoking (past (aHR = 5.69 [1.56; 20.78]) and current (3.22 [0.93; 11.09]) versus never, p = 0.01) were associated with all-cause mortality independently of SVR, age, sex, alcohol use and metabolic disorders. CONCLUSION:Any LSM >12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR.

SUBMITTER: Shili-Masmoudi S 

PROVIDER: S-EPMC6347250 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Increased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study.

Shili-Masmoudi Sarah S   Sogni Philippe P   de Ledinghen Victor V   Esterle Laure L   Valantin Marc-Antoine MA   Poizot-Martin Isabelle I   Simon Anne A   Rosenthal Eric E   Lacombe Karine K   Pialoux Gilles G   Bouchaud Olivier O   Gervais-Hasenknoff Anne A   Goujard Cécile C   Piroth Lionel L   Zucman David D   Dominguez Stéphanie S   Raffi François F   Alric Laurent L   Bani-Sadr Firouzé F   Lascoux-Combe Caroline C   Garipuy Daniel D   Miailhes Patrick P   Vittecoq Daniel D   Duvivier Claudine C   Aumaître Hugues H   Neau Didier D   Morlat Philippe P   Dabis François F   Salmon Dominique D   Wittkop Linda L  

PloS one 20190125 1


<h4>Background</h4>The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study.<h4>Methods</h4>HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ≥1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazard  ...[more]

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