Prognostic value of transient elastography (TE) in HIV/HCV infection


1292 coinfected Spanish patients were included in a retrospective study of the prognostic value of TE. All patients had undergone at least one examination with TE after it was introduced as a routine procedure to evaluate liver fibrosis in coinfected patients2006. The primary outcome was the occurrence of liver related events (LRE) defined as decompensation or hepatocellular carcinoma. 90 patients experienced LRE. The median follow up time was 5.8 years. In a subgroup of 957 patients who did notachieve sustained viral response or end of treatment response the TE result was evaluated to predict LE. A cutoff value of 12 kPa was established as a predictor of the risk of developing LE. The negative predictive value of a value below 12 kPa was 98 %.In patients with TE scores above 12 kPa there was a proportional increase hazard ratio of LE. For each kPa the hazard ratio increased 1.07 (1.05-1.08) and for 5 kPa increase above 12 the hazard ratio was 1.38 (1.31-1-46).Pérez-Latorre et al. Open Forum Infect Dis. 2016 Oct 3;3(4):ofw212Comment: The usefulness of transient elastography to classify fibrosis and predicting the risk of hepatic decompensation and hepatocellular cancer is confirmed in this important study. It is of course desirable to treat all hepatitis C infected patients as fastas possible but taking the high negative predictive value of a TE result below 12 kPa into account it seems acceptable to postpone treatment somewhat in patients with low TE scores.