Assessing mortality in women with hepatitis C virus and HIV using indirect markers of fibrosis

Kiran Bambha, Christopher Pierce, Christopher Cox, Audrey L. French, Phyllis C. Tien, Gerald B. Sharp, Michael Augenbraun, Marshall J. Glesby, Maria C. Villacres, Michael Plankey, Howard D. Strickler, Stephen J. Gange, Marion G. Peters

Research output: Contribution to journalArticle

Abstract

Objective: Co-infection with hepatitis C virus (HCV) is a major cause of morbidity and mortality in HIV-infected individuals. However, predictors of mortality are poorly defined and most studies have focused predominantly on co-infection in men. We evaluated whether two indirect markers of hepatic fibrosis, aspartate aminotransferaseto- platelet ratio index (APRI) and FIB-4 scores, were predictive of mortality in a well defined longitudinal cohort of HCV/HIV-co-infected women on HAART. Methods: HCV/HIV-co-infected women on antiretroviral therapy enrolled in Women's Interagency HIV Study (WIHS), a National Institutes of Health-funded prospective, multicenter, cohort study of women with and at risk for HIV infection were included. Using Cox regression analysis, associations between APRI and FIB-4 with all-cause mortality were assessed. Results: Four hundred and fifty HCV/HIV-co-infected women, of whom 191 women died, had a median follow-up of 6.6 years and 5739 WIHS visits. Compared with women with low APRI or FIB-4 levels, severe fibrosis was significantly associated with an increased risk of all-cause mortality {APRI: hazard ratio 2.78 [95% confidence interval (CI) 1.87, 4.12]; FIB-4: hazard ratio 2.58 (95% CI 1.68, 3.95)}. Crude death rates per 1000 patient-years increased with increasing liver fibrosis: 34.8 for mild, 51.3 for moderate and 167.9 for severe fibrosis as measured by FIB-4. Importantly, both APRI and FIB-4 increased during the 5 years prior to death for all women: the slope of increase was greater for women dying a liver-related death compared with nonliver-related death. Conclusion: Both APRI and FIB-4 are independently associated with all-cause mortality in HCV/HIV-co-infected women and may have clinical prognostic utility among women with HIV and HCV.

Original languageEnglish (US)
Pages (from-to)599-607
Number of pages9
JournalAIDS
Volume26
Issue number5
DOIs
StatePublished - Dec 7 2011

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Keywords

  • Fibrosis markers
  • HIV
  • Hepatitis C virus
  • Longitudinal study
  • Mortality

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Bambha, K., Pierce, C., Cox, C., French, A. L., Tien, P. C., Sharp, G. B., Augenbraun, M., Glesby, M. J., Villacres, M. C., Plankey, M., Strickler, H. D., Gange, S. J., & Peters, M. G. (2011). Assessing mortality in women with hepatitis C virus and HIV using indirect markers of fibrosis. AIDS, 26(5), 599-607. https://doi.org/10.1097/QAD.0b013e32834fa121