TY - JOUR
T1 - Change in fibrosis score as a predictor of mortality among HIV-infected patients with viral hepatitis
AU - Jain, Mamta K.
AU - Seremba, Emmanuel
AU - Bhore, Rafia
AU - Dao, Doan
AU - Joshi, Reeti
AU - Attar, Nahid
AU - Yuan, He Jun
AU - Lee, William M.
PY - 2012/2/1
Y1 - 2012/2/1
N2 - 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.
AB - 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.
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U2 - 10.1089/apc.2011.0191
DO - 10.1089/apc.2011.0191
M3 - Article
C2 - 22239101
AN - SCOPUS:84863033935
SN - 1087-2914
VL - 26
SP - 73
EP - 80
JO - AIDS Patient Care and STDs
JF - AIDS Patient Care and STDs
IS - 2
ER -