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Liver stiffness-based strategies predict absence of variceal bleeding in cirrhotic HCV-infected patients with and without HIV-coinfection after sustained virological response.

BACKGROUND
In the setting of HCV active infection, liver stiffness (LS)-based strategies identify patients with low risk of developing esophageal variceal bleeding (VB) episodes, in whom unnecessary upper esophagogastroduodenoscopy (UGE) screening can safely avoided. However, after sustained virological response (SVR), data on the accuracy of the criteria predictingthis outcomein HCV-infected patients with cirrhosis, with or without HIV-coinfection, are very limited.


METHODS
Multicenter prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if: 1) SVR with DAA-based therapy; 2) LS ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point≥ 14kPa. Diagnostic accuracy of HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria, at the time of SVR, wasevaluated. Missed VB episodes, negative predictive values (NPV), and number of spared UGEs were specifically assessed.


RESULTS
435patients were included, 284 (65%) coinfected with HIV. Seven(1.6%) patients developed a firstepisode of VB after SVR. In patients without a previous VB episode, HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria achieved NPV for first VB episode after SVR of 99.5% (97.1%-100%), 100% (97.8%-100%) and 100% (98%-100%) while sparing 45%, 39% and 44% of UGEs, respectively. When considering HIV-coinfection, the performance of the three criteria was similar, both in HCV-monoinfected and HIV/HCV-coinfected individuals.


CONCLUSIONS
After SVR, predictive LS-based strategies accurately identify HCV-infected patients, HIV-coinfected or not, with low risk of developing VB during follow-up. In these specific patients, using HIV cirrhosis criteria maximize the number of spared UGEs while missing no VB episode.