Incidence and Predictors of Advanced Liver Fibrosis by a Validated Serum Biomarker in Liver Transplant Recipients

Background and Aims. Serum fibrosis biomarkers have shown good accuracy in the liver transplant (LT) population. We employed a simple serum biomarker to elucidate incidence and predictors of advanced fibrosis after LT over a long follow-up period. Methods. We included 440 consecutive patients who underwent LT between 1991 and 2013. Advanced liver fibrosis was defined as FIB-4 > 3.25 beyond 12 months after LT. Results. Over 2030.5 person-years (PY) of follow-up, 189 (43%) developed FIB-4 > 3.25, accounting for an incidence of 9.3/100 PY (95% confidence interval [CI], 8.1–10.7). Advanced fibrosis was predicted by chronic HCV infection (adjusted hazard ratio (aHR) = 3.96, 95% CI 2.92–5.36, p < 0.001), hypoalbuminemia (aHR = 2.31, 95% CI 1.72–3.09; p < 0.001), and hyponatremia (aHR = 1.48, 95% CI 1.09–2.01; p = 0.01). LT recipients with more than 1 predictor had a higher incidence of advanced fibrosis, the highest being when all 3 predictors coexisted (log-rank: p < 0.001). Conclusions. Chronic HCV infection, hypoalbuminemia, and hyponatremia predict progression to advanced liver fibrosis following LT. Patients with these risk factors should be serially monitored using noninvasive fibrosis biomarkers and prioritized for interventions

Hepatic Fibrosis Progression in HIV-Hepatitis C Virus Co-Infection – The Effect of Sex on Risk of Significant Fibrosis Measured by Aspartate-to-Platelet Ratio Index

In Hepatitis C virus (HCV) mono-infection, male sex is associated with faster liver fibrosis progression but the effects of sex have not been well studied in HIV-HCV co-infected patients. We examined the influence of sex on progression to significant liver fibrosis in HIV-HCV co-infected adults receiving antiretroviral therapy (ART) using the aspartate aminotransferase-to-platelet ratio index (APRI) as a surrogate biomarker of liver fibrosis

Participant Selection Flow Chart.

<p>Participant Selection Flow Chart.</p

Sociodemographic and clinical characteristics of HIV-HCV co-infected patients at baseline by sex (2003–2012).

<p>Abbreviations: HCV, hepatitis C virus; HIV, human immunodeficiency virus; IDU, injection drug use;</p><p>APRI, aspartate aminotransferase to platelet ratio; AST, aspartate aminotransferase; BMI, body mass index;</p><p>cART, combination antiretroviral; PI, protease inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor.</p><p>^aSum of regimens >100% as some participants are on both PI, NNRTI and/or other cART.</p><p>^bFor HCVRNA VL only 166 (34/87 (39%) female and 132/221 (60%) male) had available quantitative HCV RNA values.</p><p>Sociodemographic and clinical characteristics of HIV-HCV co-infected patients at baseline by sex (2003–2012).</p

Discrete time proportional hazards models of factors associated with development of significant fibrosis (APRI ≥ 1.5) in follow-up.

<p>Abbreviations: IDU, injection drug use; HCV, hepatitis C virus; cART, combination antiretroviral; PI, protease inhibitor;</p><p>NNRTI, non-nucleoside reverse transcriptase inhibitor; APRI, aspartate aminotransferase to platelet ratio;</p><p>BMI, body mass index; HR, hazard ratio; CI, confidence interval.</p><p>Discrete time proportional hazards models of factors associated with development of significant fibrosis (APRI ≥ 1.5) in follow-up.</p

Kaplan Meier time to significant fibrosis stratified by sex.

<p>Kaplan Meier time to significant fibrosis stratified by sex.</p

Food Insecurity in HIV-Hepatitis C Virus Co-infected Individuals in Canada: The Importance of Co-morbidities

While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site (aOR: 0.42, 95 % CI: 0.27, 0.67), employment (aOR: 0.55, 95 % CI: 0.35, 0.87), and average personal monthly income (aOR per $100 CAD increase: 0.98, 95 % CI: 0.97, 0.99). Risk factors for FI included: recent injection drug use (aOR: 1.98, 95 % CI: 1.33, 2.96), trading away food (aOR: 5.23, 95 % CI: 2.53, 10.81), and recent experiences of depressive symptoms (aOR: 2.11, 95 % CI: 1.48, 3.01). FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population. Electronic supplementary material The online version of this article (doi:10.1007/s10461-016-1326-9) contains supplementary material, which is available to authorized users