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

Mamta K. Jain, Emmanuel Seremba, Rafia Bhore, Doan Dao, Reeti Joshi, Nahid Attar, He Jun Yuan, William M. Lee

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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.

Original languageEnglish (US)
Pages (from-to)73-80
Number of pages8
JournalAIDS Patient Care and STDs
Volume26
Issue number2
DOIs
StatePublished - Feb 1 2012

Fingerprint

Hepatitis
Fibrosis
HIV
Mortality
Liver Cirrhosis
Life Tables
Survival
Social Security
Liver
Kaplan-Meier Estimate
Aspartate Aminotransferases
Coinfection
Hepatitis B virus
Hepacivirus
Blood Platelets
Retrospective Studies

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Change in fibrosis score as a predictor of mortality among HIV-infected patients with viral hepatitis. / Jain, Mamta K.; Seremba, Emmanuel; Bhore, Rafia; Dao, Doan; Joshi, Reeti; Attar, Nahid; Yuan, He Jun; Lee, William M.

In: AIDS Patient Care and STDs, Vol. 26, No. 2, 01.02.2012, p. 73-80.

Research output: Contribution to journalArticle

Jain, Mamta K. ; Seremba, Emmanuel ; Bhore, Rafia ; Dao, Doan ; Joshi, Reeti ; Attar, Nahid ; Yuan, He Jun ; Lee, William M. / Change in fibrosis score as a predictor of mortality among HIV-infected patients with viral hepatitis. In: AIDS Patient Care and STDs. 2012 ; Vol. 26, No. 2. pp. 73-80.
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AU - Yuan, He Jun

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