Corma-Gómez Anaïs, Corona-Mata Diana, Martín-Carmona Jésica, Galindo María José, Camacho Angela, Martín-Sierra Carmen, Gallo-Marín Marina, Rincón Pilar, Perez-Valero Ignacio, Pérez-García Margarita, Carrasco-Dorado Angela, Pineda Juan A, Rivero-Juárez Antonio, Rivero Antonio, Real Luis M, Macías Juan
Grupo de Virología Clínica e ITS Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, de Hospital Universitario Virgen de Valme, Sevilla, Spain.
Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain.
Open Forum Infect Dis. 2025 Apr 8;12(4):ofae628. doi: 10.1093/ofid/ofae628. eCollection 2025 Apr.
Liver stiffness (LS) predicts liver complication occurrence in patients with hepatitis C virus (HCV) infection after sustained virological response (SVR). The FibroScan-AST (FAST) score, which includes aspartate aminotransferase (AST) and controlled attenuation parameter (CAP; measured by FibroScan), may improve the prediction ability of isolated LS. Our aim was to compare the predictive capacity of LS vs FAST in this setting.
Multicenter cohort study including individuals with HIV/HCV coinfection or HCV monoinfection from Spain if they had (1) LS ≥9.5 kPa pretreatment, (2) SVR with a direct-acting antiviral (DAA)-based regimen, and (3) LS and CAP measurement at SVR. Fatty liver disease (FLD) was defined as CAP ≥248 dB/m. The primary outcome was the occurrence of a liver complication (decompensation or hepatocellular carcinoma [HCC]) after SVR.
Three hundred patients were included; 213 (71%) had HIV. At SVR, 131 (44%) had FLD. The FAST score was <0.35 in 182 (61%), 0.35-0.67 in 79 (27%), and >0.67 in 34 (12%) patients. After a median (Q1-Q3) follow-up of 73 (53-83) months, 36 (12%) liver complications (15 [5%] HCC) occurred. LS was independently associated with an increased risk of developing liver complications (sub-hazard ratio [sHR], 1.06; 95% CI, 1.04-1.08; < .001). In a separate model, FAST ≥0.35 was also independently associated with greater risk of liver complications (sHR, 8.12; 95% CI, 3.11-21.17; < .001). The area under the receiver operating characteristics curve of the model based on LS was 0.83 (95% CI, 0.76-0.91), and that of the model based on FAST was 0.80 (95% CI, 0.72-0.88; = .158).
The FAST score predicts the development of liver events after SVR but does not improve the predictive capacity of LS alone at this time point.
肝硬度（LS）可预测丙型肝炎病毒（HCV）感染患者在持续病毒学应答（SVR）后发生肝脏并发症的情况。FibroScan-天门冬氨酸氨基转移酶（AST）（FAST）评分，包括天门冬氨酸氨基转移酶（AST）和受控衰减参数（CAP；通过FibroScan测量），可能会提高单独LS的预测能力。我们的目的是比较在这种情况下LS与FAST的预测能力。
多中心队列研究，纳入来自西班牙的HIV/HCV合并感染或HCV单一感染个体，条件为：（1）治疗前LS≥9.5 kPa；（2）基于直接抗病毒药物（DAA）方案实现SVR；（3）在SVR时测量LS和CAP。脂肪肝疾病（FLD）定义为CAP≥248 dB/m。主要结局是SVR后发生肝脏并发症（失代偿或肝细胞癌[HCC]）。
共纳入300例患者；213例（71%）合并HIV。在SVR时，131例（44%）有FLD。182例（61%）患者的FAST评分<0.35，79例（27%）为0.35 - 0.67，34例（12%）>0.67。在中位（四分位间距）随访73（53 - 83）个月后，发生36例（12%）肝脏并发症（15例[5%] HCC）。LS与发生肝脏并发症的风险增加独立相关（亚风险比[sHR]，1.06；95%置信区间[CI]，1.04 - 1.08；P <.001）。在另一个模型中，FAST≥0.35也与肝脏并发症风险增加独立相关（sHR，8.12；95% CI，3.11 - 21.17；P <.001）。基于LS的模型的受试者工作特征曲线下面积为0.83（95% CI，0.76 - 0.91），基于FAST的模型的受试者工作特征曲线下面积为0.80（95% CI，0.72 - 0.88；P =.158）。
FAST评分可预测SVR后肝脏事件的发生，但在该时间点并不能单独提高LS的预测能力。
