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  ICAAC 2015 55th Interscience Conference
on Antimicrobial Agents and Chemotherapy
September 5-9, 2015, San Diego, CA
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FIB-4 Linked to All-Cause Mortality in Large Italian HIV/HCV Cohort
  FIB-4 Linked to All-Cause Mortality in Large Italian HIV/HCV Cohort
ICAAC 2015, September 17-21, 2015, San Diego
Mark Mascolini
A FIB-4 score indicating severe fibrosis doubled chances of all-cause mortality in a prospective cohort of 3338 people coinfected with HIV and HCV and taking antiretroviral therapy (ART) [1]. HCV RNA clearance and a FIB-4 indicating mild fibrosis predicted lower odds of death.
Based on easily obtained values (age, alanine and aspartate aminotransferase [ALT, AST], platelet count) [2], FIB-4 has proved useful in predicting severe fibrosis in people coinfected with HCV and HIV. Researchers involved in the Italian MASTER cohort conducted this prospective study to see whether FIB-4 predicts mortality in people with HIV and HCV.
The cohort includes about 24,500 HIV-positive adults in care at eight centers in Bari, Bergamo, Brescia, Cremona, Ferrara, Florence, Monza, and Rome. MASTER cohort members are evaluated clinically every 3 months. Researchers restricted this analysis to HIV/HCV-coinfected people taking ART and with FIB-4 data available from (1) their first study visit on ART (the index visit), and (2) at least one follow-up visit. The analysis excluded people positive for hepatitis B surface antigen and those with ALT or AST more than 10 times the upper limit of normal or platelets above 25,000 per million cells/L.
Of the 3338 HIV/HCV-coinfected people included in the analysis, 291 (8.7%) died from any cause during 45,081 person-years of follow-up. Gender, age, and Italian versus non-Italian origin did not differ significantly between people who died and survivors. FIB-4 predicted F4 fibrosis in 39.5% who died and 15.5% who did not. While 10.7% who cleared HCV RNA died, 23.2% who cleared HCV RNA survived.
Multivariate analysis identified four independent predictors of all-cause mortality. Clinical AIDS before ART began and F4 fibrosis on FIB-4 (> or = 3.25) raised the risk of death, whereas HCV RNA clearance and F0-F1 fibrosis on FIB-4 (<1.45) lowered the risk, at the following adjusted odds ratios (aOR) and 95% confidence intervals:
-- Clinical AIDS before ART: aOR 1.5 (1.0 to 2.3), P = 0.03
-- F4 fibrosis: aOR 2.1 (1.5 to 3.1), P < 0.000
-- F0-F1 fibrosis: aOR 0.6 (0.4 to 0.8), P = 0.004
-- HCV RNA clearance: aOR 0.4 (0.2 to 0.6), P < 0.000
The MASTER team proposed that high mortality in people with severe fibrosis score suggests that fibrosis contributed to death even in those deemed to have died from HIV infection. Noting that FIB-4 was abnormal years before death, the researchers suggested that "this noninvasive marker can be of value in all subjects coinfected with HIV and HCV to determine whether liver disease is progressing and, if so, to reinforce the need for therapy for HCV."
1. Nasta P, Giralda M, Spinetti A, et al. Assessing mortality in patients with hepatitis C virus and HIV, using indirect markers of fibrosis (MASTER cohort). ICAAC 2015, September 17-21, 2015, San Diego. Abstract H-1217.
2. Hepatitis C Online. Fibrosis-4 (FIB-4) calculator. http://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4