Prognostic value of non‐invasive scores based on liver stiffness measurement, spleen diameter and platelets in HIV‐infected patients

Background and Aims People living with HIV (PLWH) are at high risk for advanced chronic liver disease and related adverse outcomes. We aimed to validate the prognostic value of non‐invasive scores based on liver stiffness measurement (LSM) and on markers of portal hypertension (PH), namely platelets and spleen diameter, in PLWH. Methods We combined data from eight international cohorts of PLWH with available non‐invasive scores, including LSM and the composite biomarkers liver stiffness‐spleen size‐to‐platelet ratio score (LSPS), LSM‐to‐Platelet ratio (LPR) and PH risk score. Incidence and predictors of all‐cause mortality, any liver‐related event and classical hepatic decompensation were determined by survival analysis, controlling for competing risks for the latter two. Non‐invasive scores were assessed and compared using area under the receiver operating curve (AUROC). Results We included 1695 PLWH (66.8% coinfected with hepatitis C virus). During a median follow‐up of 4.7 (interquartile range 2.8–7.7) years, the incidence rates of any liver‐related event, all‐cause mortality and hepatic decompensation were 13.7 per 1000 persons‐year (PY) (95% confidence interval [CI], 11.4–16.3), 13.8 per 1000 PY (95% CI, 11.6–16.4) and 9.9 per 1000 PY (95% CI, 8.1–12.2), respectively. The AUROC of LSM was similar to that of the composite biomarkers, ranging between 0.83 and 0.86 for any liver‐related event, 0.79–0.85 for all‐cause mortality and 0.87–0.88 for classical hepatic decompensation. All individual non‐invasive scores remained independent predictors of clinical outcomes in multivariable analysis. Conclusions Non‐invasive scores based on LSM, spleen diameter and platelets predict clinical outcomes in PLWH. Composite biomarkers do not achieve higher prognostic performance compared to LSM alone.