1Viral Infection and Immunity Unit, National Centre of Microbiology. Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. 2Infectious Diseases and HIV Unit; Hospital General Universitario Gregorio Marañón, Madrid, Spain. 3Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain 4Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5Pathology Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
To assess the ability of the cirrhosis risk score (CRS) to predict liver fibrosis progression in HIV/HCV coinfected patients.
Retrospective follow-up study.
Based on a minimum follow-up time of 10 years with HCV infection, 190 HIV/HCV coinfected patients were classified according to their METAVIR score: i) 25 non-progressor patients who did not develop fibrosis (F0); and ii) 165 progressor patients who developed fibrosis (F≥1). Seven polymorphisms of CRS signature and IL28B genotype were performed using the GoldenGate® assay. The CRS signature was calculated by Naïve Bayes formula as previously described.
Non-progressors had CRS values significantly lower than progressors (0.61 versus 0.67; p=0.043). Among the progressors, we observed similar CRS values through all the fibrosis stages (F1/F2/F3/F4). The percentage of patients with CRS>0.70 (high-risk of developing fibrosis) was higher in progressors than in non-progressors; but the percentages with values between 0.50-0.70 (intermediate risk) and <0.50 (low risk) were quite similar for each of the fibrosis stages (p=0.047). The area under the receiver operating characteristic curve (AUROC) of CRS for discriminating non-progressor versus progressor was 0.625 (p=0.043). When clinical variables were considered (age at HCV infection, IDU, gender, IL28B and HCV genotype), the AUROC of CRS improved up to 0.739 (p<0.001).
CRS itself seems not to be a good marker for identifying HIV/HCV coinfected patients who are at high risk of developing liver fibrosis. However, CRS score coupled with clinical factors might help to distinguish between non-progressors and progressors patients.