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Liver-related events in HIV-infected persons with occult cirrhosis

Benmassaoud, Amine, Nitulescu, Roy, Pembroke, Thomas, Halme, Alex S., Ghali, Peter, Deschenes, Marc, Wong, Philip, Klein, Marina B. and Sebastian, Giada 2019. Liver-related events in HIV-infected persons with occult cirrhosis. Clinical Infectious Diseases 69 (8) , pp. 1422-1430. 10.1093/cid/ciy1082

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Background Human immunodeficiency virus (HIV)-infected patients are at increased risk of liverrelated mortality. The effect of occult cirrhosis (OcC), defined as preclinical compensated cirrhosis without any clinical findings, on liver-related events is unknown. Methods HIV-infected patients from two Canadian cohorts underwent transient elastography (TE) examination and were classified as: 1) OcC (TE ≥13 kPa with no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); 2) overt cirrhosis (OvC) (TE ≥13 kPa with signs of cirrhosis); 3) non-cirrhotic patients (TE <13 kPa). Incidence and risk factors of liverrelated events were investigated through Kaplan-Meier and Cox regression analyses, respectively. We estimated monitoring rates according to screening guidelines for hepatocellular carcinoma (HCC) by OcC and OvC status. Results 1092 HIV-infected patients (51% coinfected with hepatitis C virus) were included. Prevalence of OcC and OvC at baseline was 2.7% and 10.7%, respectively. During a median follow-up of 1.8 (interquartile range: 1.5– 2.8) years, the incidence of liverrelated events in non cirrhotics, OcC, and OvC was 3.4 (95% confidence interval [CI]: 1.2-7.3), 34 (95% CI: 6-104), and 37 (95% CI: 16.95-69.05) per 1000 person-years, respectively. Baseline OcC (adjusted hazard ratio [aHR]: 7.1, 95% CI: 1.3-38) and OvC (aHR: 8.5, 95% CI: 2.8-26) were independently associated with liver-related events.Monitoring rates for HCC were lower in patients with OcC (24%) compared to those with OvC (40%). Conclusions HIV-infected patients with OcC have a high incidence of liver-related events. Greater surveillance and earlier recognition with appropriate screening strategies is necessary for improved outcomes.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: University of Chicago Press
ISSN: 1058-4838
Date of First Compliant Deposit: 17 December 2018
Date of Acceptance: 11 December 2018
Last Modified: 15 Mar 2020 05:48

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