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Increased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study.
- Source :
-
PloS one [PLoS One] 2019 Jan 25; Vol. 14 (1), pp. e0211286. Date of Electronic Publication: 2019 Jan 25 (Print Publication: 2019). - Publication Year :
- 2019
-
Abstract
- Background: The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study.<br />Methods: HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ≥1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates.<br />Results: 1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4-49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2-6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM ≤12.5 kPa and 10.8% for patients with LSM >12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p<0.0001), history of HCV treatment (aHR = 0.53 [0.32; 0.90], p = 0.01) and smoking (past (aHR = 5.69 [1.56; 20.78]) and current (3.22 [0.93; 11.09]) versus never, p = 0.01) were associated with all-cause mortality independently of SVR, age, sex, alcohol use and metabolic disorders.<br />Conclusion: Any LSM >12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Adult
Antiviral Agents therapeutic use
Coinfection diagnostic imaging
Coinfection drug therapy
Elasticity Imaging Techniques
Female
France
HIV Infections diagnostic imaging
HIV Infections drug therapy
Hepatitis C, Chronic diagnostic imaging
Hepatitis C, Chronic drug therapy
Humans
Male
Middle Aged
Mortality
Proportional Hazards Models
Prospective Studies
Risk Factors
Sustained Virologic Response
Coinfection mortality
HIV Infections mortality
Hepatitis C, Chronic mortality
Liver diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 14
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 30682180
- Full Text :
- https://doi.org/10.1371/journal.pone.0211286