- Category: Fibrosis & Cirrhosis
- Published on Friday, 13 July 2012 00:00
- Written by Liz Highleyman
Transient elastography, better known as FibroScan, is an accurate method for predicting liver-related clinical events and death in HIV positive people coinfected with hepatitis C virus (HCV), according to a study described in the July 2012 issue of Hepatology.
Transient elastography uses sound waves to measure liver stiffness, which increases as fibrosis worsens. Biopsies are considered the "gold standard" for determining the extent of liver damage, but non-invasive methods like FibroScan are more convenient, cheaper, and less uncomfortable, and therefore may be a better option for repeated measurements over time.
Elastography tends to be better at diagnosing minimal versus severe fibrosis, and is less accurate at distinguishing between intermediate stages; there is some controversy about whether this method predicts clinical outcomes associated with liver disease progression.
Nicolás Merchante and fellow researchers with Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) in Spain prospectively assessed the predictive value of liver stiffness for clinical outcomes among 239 consecutive HIV/HCV patients with compensated liver cirrhosis. The researchers looked at the time from diagnosis of cirrhosis by transient elastography to first episodes of liver decompensation and death due to liver disease.
- After a median follow-up period of 20 months, a total of 31 patients (13%) experienced decompensation, an incidence rate of 6.7 cases per 100 person-years.
- 8% of patients with a baseline liver stiffness measurement < 40 kiloPascals (kPa) developed decompensation, compared with 29% of those with measurements > 40 kPa, a statistically significant difference.
- The following factors were independently associated with decompensation:
o Triple infection with hepatitis B virus: hazard ratio (HR) 10.3, or about 10-fold higher risk;
o Child-Turcotte-Pugh (CTP) class B versus A: HR 7.7, or nearly 8 times higher risk;
o Higher HCV RNA viral load: HR 2.1, or about twice the risk;
- Higher baseline liver stiffness was associated with a small risk increase of borderline significance (HR 1.03).
- A total of 15 patients (6%) died during follow-up, 10 of them due to liver disease, and 1 person underwent liver transplantation.
- CTP class B (HR 16.5) and previous hepatitis C treatment (HR 7.4) were independently associated with liver-related death.
- Baseline liver stiffness again was of borderline significance (HR 1.03).
Based on these findings, the researchers concluded, "Liver stiffness predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score."
"Earlier recognition of cirrhosis and optimal treatment of cirrhotic patients at the initial stages are critical," Merchante stated in a news release issued by Hepatology publisher Wiley-Blackwell. "Our findings indicate that liver stiffness predicts risk of liver failure and liver-related deaths in patients with compensated cirrhosis who are coinfected with HIV and HCV, providing more advanced detection of disease severity."
N Merchante, A Rivero-Juárez, F Téllez, et al (Grupo Andaluz para el Estudio de las Hepatitis Víricas). Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis. Hepatology 56(1):228-238. July 2012.
Wiley-Blackwell. Liver Stiffness Predicts Liver Failure, Cancer and Mortality. News release. July 10, 2012.