Liver Stiffness-Based Strategies Predict Absence of Variceal Bleeding in Cirrhotic Hepatitis C Virus-Infected Patients With and Without Human Immunodeficiency Virus Coinfection After Sustained Virological Response Corma Gómez, Anaïs Macías, Juan Morano, Luis Rivero, Antonio Tellez, Francisco Ríos, María José Santos, Marta Serrano, Miriam Palacios, Rosario Merino, Dolores Real, Luis Miguel De los Santos, Ignacio Vera-Méndez, Francisco J Galindo, Maria José Pineda, Juan Antonio RIS-HEP13 and GEHEP 011 Study Groups HCV infection Sustained virological response (SVR) Ddirect-acting antivirals Liver stiffness Variceal bleeding This work was supported in part by the Instituto de Salud Carlos III (ISCIII; project numbers PI16/01443 and PI19/01312), integrated in the national I+D+i 2013–2016 and 2016–2019 and co-funded by the European Union (ERDF/ESF, “Investing in your future”); and by the Spanish Network for AIDS Investigation (www.red.es/redes/inicio) (RD16/0025/0040), as a part of the Nacional I+ D+I, ISCIII Subdirección General de Evaluación and the European Fund for Development of Regions and by Grupo de Estudio para las Hepatitis Víricas-Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica GEHEP-SEIMC (GEHEP-011 project). J. A. P. has received a research extension grant from the Programa de Intensificación de la Actividad de Investigación del Servicio Nacional de Salud Carlos III. A. C.-G. has received a Río Hortega grant from ISCIII (grant number CM19/00251). Background: In the setting of hepatitis C virus (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 be safely avoided. However, after sustained virological response (SVR), data on the accuracy of the criteria predicting this outcome in HCV-infected patients with cirrhosis, with or without human immunodeficiency virus (HIV) coinfection, are very limited. Methods: This was a multicenter prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they had (1) SVR with direct-acting antiviral-based therapy; (2) LS ≥9.5 kPa previous to treatment; and (3) LS measurement at the SVR time-point ≥14 kPa. Diagnostic accuracy of HEPAVIR, expanded Baveno VI, and HIV cirrhosis criteria, at the time of SVR, was evaluated. Missed VB episodes, negative predictive values (NPVs), and number of spared UGEs were specifically assessed. Results: Four hundred thirty-five patients were included, 284 (65%) coinfected with HIV. Seven (1.6%) patients developed a first episode 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% (95% confidence interval [CI], 97.1%-100%), 100% (95% CI 97.8%-100%), and 100% (95% CI 98%-100%) while sparing 45%, 39%, and 44% of UGEs, respectively. When considering HIV coinfection, the performance of the 3 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 2024-04-22T06:52:13Z 2024-04-22T06:52:13Z 2021-03 journal article Corma-Gómez, Anaïs et al. Liver Stiffness–Based Strategies Predict Absence of Variceal Bleeding in Cirrhotic Hepatitis C Virus–Infected Patients With and Without Human Immunodeficiency Virus Coinfection After Sustained Virological Response, Clinical Infectious Diseases, Volume 72, Issue 5, 1 March 2021, Pages e96–e102, https://doi.org/10.1093/cid/ciaa1726 https://hdl.handle.net/10481/90962 10.1093/cid/ciaa1726 eng http://creativecommons.org/licenses/by-nc-nd/3.0/ open access Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License Oxford University Press