Bordeaux Population Health Research Center, ISPED, Inserm, Team MORPH3EUS, UMR 1219, Bordeaux University.
Liver Unit, Paris Public Hospitals, Cochin Hospital, INSERM U-1223, PasteurInstitute, Paris-Descartes University.
Eur J Gastroenterol Hepatol. 2019 Nov;31(11):1387-1396. doi: 10.1097/MEG.0000000000001408.
HIV/hepatitis C virus (HCV) co-infection leads to major complications, and noninvasive markers developed to stage liver fibrosis could be used as prognostic markers. We aimed to compare the performances of liver stiffness (LS), fibrosis-4 (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) to predict liver-related events in HIV/HCV co-infected patients.
HIV/HCV co-infected patients from the ANRS CO13 HEPAVIH cohort were included if they had LS, FIB-4, and APRI measurements done in a window of 3 months. Primary outcome was the time between inclusion and occurrence of a liver-related event. Univariable and multivariable Fine and Gray models were performed. Predictive performances were compared by the area under the receiver operating characteristic (AUROC) differences after correction of optimistic by bootstrap samples. Best cutoffs to predict liver-related events were estimated by sensitivity and specificity maximization.
A total of 998 patients were included. Overall, 70.7% were men. Their median age was 46.8 years. According to LS value, 204 (20.4%) patients had cirrhosis. Overall, 39 patients experienced at least one liver-related event. In univariable analysis, LS AUROC curve was significantly superior to FIB-4 and APRI AUROC curves, being 87.9, 78.2, and 75.0%, respectively. After adjustment on age, CD4 levels, and insulin resistance, no differences were observed. The best cutoffs to identify patients at low or high risk of liver-related events were below 8.5, 1.00, and 0.35 and above 16.5, 4.00, and 1.75 for LS, FIB-4, and APRI, respectively.
To predict HCV-related events, APRI had lower performance than LS and FIB-4. FIB-4 is as good as LS to predict HCV-related events, suggesting that it can be used for the management of HIV/HCV co-infected patients and replace LS.
HIV/丙型肝炎病毒（HCV）合并感染可导致严重并发症，开发用于分期肝纤维化的非侵入性标志物可作为预后标志物。我们旨在比较肝硬度（LS）、纤维化-4（FIB-4）和天冬氨酸氨基转移酶与血小板比值指数（APRI）预测 HIV/HCV 合并感染患者肝相关事件的性能。
如果 HIV/HCV 合并感染患者在 3 个月的窗口期内进行了 LS、FIB-4 和 APRI 测量，则将其纳入 ANRS CO13 HEPAVIH 队列。主要结局是从纳入到发生肝相关事件之间的时间。进行单变量和多变量 Fine 和 Gray 模型。通过bootstrap 样本校正后的接收者操作特征（ROC）差异比较预测性能。通过敏感性和特异性最大化估计预测肝相关事件的最佳截断值。
共纳入 998 例患者。总体而言，70.7%为男性，中位年龄为 46.8 岁。根据 LS 值，204 例（20.4%）患者患有肝硬化。总体而言，39 例患者至少发生了一次肝相关事件。在单变量分析中，LS 的 AUROC 曲线明显优于 FIB-4 和 APRI 的 AUROC 曲线，分别为 87.9%、78.2%和 75.0%。调整年龄、CD4 水平和胰岛素抵抗后，无差异。LS、FIB-4 和 APRI 用于识别低或高肝相关事件风险患者的最佳截断值分别为 8.5 以下、1.00 以上和 0.35 以下，16.5 以上、4.00 以上和 1.75 以上。
APRI 预测 HCV 相关事件的性能低于 LS 和 FIB-4。FIB-4 与 LS 一样可用于预测 HCV 相关事件，表明它可用于 HIV/HCV 合并感染患者的管理，并可替代 LS。
