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Assessment of liver fibrosis and associated risk factors in HIV-infected individuals using transient elastography and serum biomarkers.

Vermehren J, Vermehren A, Mueller A, Carlebach A, Lutz T, Gute P, Knecht G, Sarrazin C, Friedrich-Rust M, Forestier N, Poynard T, Zeuzem S, Herrmann E, Hofmann WP - BMC Gastroenterol (2012)

Bottom Line: Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals.In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).Chronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medizinische Klinik 1, Klinikum der J, W, Goethe-Universität, Frankfurt am Main, Germany. hofmann@med.uni-frankfurt.de

ABSTRACT

Background: Liver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to co-infection with hepatitis B or C. The impact of other risk factors, including prolonged exposure to combined antiretroviral therapy (cART) is poorly understood. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]).

Methods: In 202 consecutive HIV-infected individuals (159 men; mean age 47 ± 9 years; 35 with hepatitis-C-virus [HCV] co-infection), TE and FT were performed. Repeat TE examinations were conducted 1 and 2 years after study inclusion.

Results: Significant liver fibrosis was present in 16% and 29% of patients, respectively, when assessed by TE (≥ 7.1 kPa) and FT (> 0.48). A combination of TE and FT predicted significant fibrosis in 8% of all patients (31% in HIV/HCV co-infected and 3% in HIV mono-infected individuals). Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals. Overall, factors independently associated with significant fibrosis as assessed by TE (OR, 95% CI) were co-infection with HCV (7.29, 1.95-27.34), chronic AST (6.58, 1.30-33.25) and γ-GT (5.17, 1.56-17.08) elevation and time on dideoxynucleoside therapy (1.01, 1.00-1.02). In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).

Conclusions: Chronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART. However, only a small subset had significant fibrosis as predicted by TE and FT. There was no evidence for fibrosis progression during follow-up TE examinations.

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Box plots of median liver stiffness (TE) values at baseline and follow-up in 68 patients with HIV mono-infection (p = 0.20). All data were log10-transformed. The top and bottom of each box represent the first and third quartiles respectively. The middle line represents the median. Pooled follow-up TE values are shown for the last available TE examination in each patient. Median follow-up time was 24 months (range, 9-27 months).
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Figure 1: Box plots of median liver stiffness (TE) values at baseline and follow-up in 68 patients with HIV mono-infection (p = 0.20). All data were log10-transformed. The top and bottom of each box represent the first and third quartiles respectively. The middle line represents the median. Pooled follow-up TE values are shown for the last available TE examination in each patient. Median follow-up time was 24 months (range, 9-27 months).

Mentions: The median liver stiffness at the end of follow-up (last examination available in each patient) was 4.9 kPa (range, 2.9-20.2 kPa; Figure 1).


Assessment of liver fibrosis and associated risk factors in HIV-infected individuals using transient elastography and serum biomarkers.

Vermehren J, Vermehren A, Mueller A, Carlebach A, Lutz T, Gute P, Knecht G, Sarrazin C, Friedrich-Rust M, Forestier N, Poynard T, Zeuzem S, Herrmann E, Hofmann WP - BMC Gastroenterol (2012)

Box plots of median liver stiffness (TE) values at baseline and follow-up in 68 patients with HIV mono-infection (p = 0.20). All data were log10-transformed. The top and bottom of each box represent the first and third quartiles respectively. The middle line represents the median. Pooled follow-up TE values are shown for the last available TE examination in each patient. Median follow-up time was 24 months (range, 9-27 months).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3361499&req=5

Figure 1: Box plots of median liver stiffness (TE) values at baseline and follow-up in 68 patients with HIV mono-infection (p = 0.20). All data were log10-transformed. The top and bottom of each box represent the first and third quartiles respectively. The middle line represents the median. Pooled follow-up TE values are shown for the last available TE examination in each patient. Median follow-up time was 24 months (range, 9-27 months).
Mentions: The median liver stiffness at the end of follow-up (last examination available in each patient) was 4.9 kPa (range, 2.9-20.2 kPa; Figure 1).

Bottom Line: Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals.In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).Chronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medizinische Klinik 1, Klinikum der J, W, Goethe-Universität, Frankfurt am Main, Germany. hofmann@med.uni-frankfurt.de

ABSTRACT

Background: Liver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to co-infection with hepatitis B or C. The impact of other risk factors, including prolonged exposure to combined antiretroviral therapy (cART) is poorly understood. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]).

Methods: In 202 consecutive HIV-infected individuals (159 men; mean age 47 ± 9 years; 35 with hepatitis-C-virus [HCV] co-infection), TE and FT were performed. Repeat TE examinations were conducted 1 and 2 years after study inclusion.

Results: Significant liver fibrosis was present in 16% and 29% of patients, respectively, when assessed by TE (≥ 7.1 kPa) and FT (> 0.48). A combination of TE and FT predicted significant fibrosis in 8% of all patients (31% in HIV/HCV co-infected and 3% in HIV mono-infected individuals). Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals. Overall, factors independently associated with significant fibrosis as assessed by TE (OR, 95% CI) were co-infection with HCV (7.29, 1.95-27.34), chronic AST (6.58, 1.30-33.25) and γ-GT (5.17, 1.56-17.08) elevation and time on dideoxynucleoside therapy (1.01, 1.00-1.02). In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).

Conclusions: Chronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART. However, only a small subset had significant fibrosis as predicted by TE and FT. There was no evidence for fibrosis progression during follow-up TE examinations.

Show MeSH
Related in: MedlinePlus