Journal
CLINICAL INFECTIOUS DISEASES
Volume 71, Issue 11, Pages 2810-2817Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciz1181
Keywords
esophagogastroduodenoscopy; transient elastography; Baveno VI criteria; HCV coinfection; variceal bleeding
Categories
Funding
- ViiV
- Merck
- Fonds de Recherche Sante du Quebec [27127, 267806]
- Dt. Leberstiftung, German Center for Infection Research (DZIF), Hector Stiftung
- European treatment network for HIV, hepatitis and global infectious diseases
- Consejeria de Salud de la Junta de Andalucia [PI-0014/2014]
- Servicio Andaluz de Salud [SAS/111239]
- Fondo de Investigaciones Sanitarias ISCIII [PI13/01621]
- Instituto de Salud Carlos III [PI16/01443, I3SNS]
- European Union (European Regional Development Fund/European Social Fund, Investing in your future)
- Ministerio de Ciencia, Promocion y Universidades of Spain [CP18/00111]
- Spanish AIDS Research Network [RD16/0025/0010]
- Instituto de Salud Carlos III Subdireccion General de Evaluacion y el Fondo Europeo de Desarrollo Regional
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Background. People living with human immunodeficiency virus (PLWH) are at increased risk of cirrhosis and esophageal varices. Baveno VI criteria, based on liver stiffness measurement (LSM) and platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for esophageal varices needing treatment (EVNT). This approach has not been validated in PLWH. Methods. PLWH from 8 prospective cohorts were included if they fulfilled the following criteria: (1) compensated advanced chronic liver disease (LSM >10 kPa); (2) availability of EGD within 6 months of reliable LSM. Baveno VI (LSM <20 kPa and platelets >150 000/mu L), expanded Baveno VI (LSM <25 kPa and platelets >110 000/mu L), and Estudio de las Hepatitis Viricas (HEPAVIR) criteria (LSM <21 kPa) were applied to identify patients not requiring EGD screening. Criteria optimization was based on the percentage of EGDs spared, while keeping the risk of missing EVNT <5%. Results. Five hundred seven PLWH were divided into a training (n = 318) and a validation set (n = 189). EVNT were found in 7.5%. In the training set, Baveno VI, expanded Baveno VI, and HEPAVIR criteria spared 10.1%, 25.5%, and 28% of EGDs, while missing 0%, 1.2%, and 2.2% of EVNT, respectively. The best thresholds to rule out EVNT were platelets >110 000/mu L and LSM <30 kPa (HIV cirrhosis criteria), with 34.6% of EGDs spared and 0% EVNT missed. In the validation set, HEPAVIR and HIV cirrhosis criteria spared 54% and 48.7% of EGDs, while missing 4.9% and 2.2% EVNT, respectively. Conclusions. Baveno VI criteria can be extended to HEPAVIR and HIV cirrhosis criteria while sparing a significant number of EGDs, thus improving resource utilization for PLWH with compensated advanced chronic liver disease.
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