Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis.
AIDS
; 31(4): 493-500, 2017 02 20.
Article
em En
| MEDLINE
| ID: mdl-27922855
ABSTRACT
BACKGROUND:
A liver stiffness below 21âkPa has a high negative predictive value to exclude the presence of esophageal varices at risk of bleeding in HIV/hepatitis C virus (HCV)-coinfected patients. Consequently, upper gastrointestinal endoscopy (UGE) for the screening of esophageal varices could be avoided in these patients. However, this strategy has not been widely accepted due to concerns about its safety.OBJECTIVE:
To assess the ability of liver stiffness to predict the risk of portal hypertensive gastrointestinal bleeding (PHGB) in HIV/HCV-coinfected patients with compensated cirrhosis.METHODS:
Prospective study of 446 HIV/HCV-coinfected patients with a new diagnosis of cirrhosis and no previous decompensation. All patients underwent a UGE for the screening of esophageal varices at entry in the cohort before November 2009. From this date, UGE was not recommended in patients with liver stiffness below 21âkPa. The time from diagnosis of cirrhosis to the emergence of PHGB was evaluated.RESULTS:
After a median (quartile1-quartile3) follow-up of 49 (25-68) months, 15 (3.4%, 95% confidence interval 1.7-5%) patients developed a first PHGB episode. In all cases, baseline liver stiffness was at least 21âkPa. Thus, the negative predictive value of a liver stiffness below 21âkPa to predict PHGB during follow-up was 100%. At the time of the bleeding episode, liver stiffness was above this threshold in all patients.CONCLUSIONS:
Liver stiffness identifies HIV/HCV-coinfected patients with compensated cirrhosis with a very low risk of PHGB. In fact, no individual with liver stiffness below 21âkPa developed this outcome. Our results confirm that UGE can be safely spared in patients with liver stiffness below 21âkPa.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Varizes Esofágicas e Gástricas
/
Infecções por HIV
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Hepatite C Crônica
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Coinfecção
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Hemorragia Gastrointestinal
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Fígado
/
Cirrose Hepática
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2017
Tipo de documento:
Article