PLoS ONE (Jan 2019)

Increased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study.

  • Sarah Shili-Masmoudi,
  • Philippe Sogni,
  • Victor de Ledinghen,
  • Laure Esterle,
  • Marc-Antoine Valantin,
  • Isabelle Poizot-Martin,
  • Anne Simon,
  • Eric Rosenthal,
  • Karine Lacombe,
  • Gilles Pialoux,
  • Olivier Bouchaud,
  • Anne Gervais-Hasenknoff,
  • Cécile Goujard,
  • Lionel Piroth,
  • David Zucman,
  • Stéphanie Dominguez,
  • François Raffi,
  • Laurent Alric,
  • Firouzé Bani-Sadr,
  • Caroline Lascoux-Combe,
  • Daniel Garipuy,
  • Patrick Miailhes,
  • Daniel Vittecoq,
  • Claudine Duvivier,
  • Hugues Aumaître,
  • Didier Neau,
  • Philippe Morlat,
  • François Dabis,
  • Dominique Salmon,
  • Linda Wittkop,
  • ANRS CO13 HEPAVIH study group

DOI
https://doi.org/10.1371/journal.pone.0211286
Journal volume & issue
Vol. 14, no. 1
p. e0211286

Abstract

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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. 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. 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], p12.5 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.