Relationship between various hepatic function scores and the formation of esophageal varices in patients with HIV/HCV coinfection due to contaminated blood products for hemophilia.

BACKGROUND: It was reported to be difficult to accurately assess the liver reserve capacity of patients with HIV/HCV coinfection through contaminated blood products by the Child-Pugh (CP) classification. Therefore, we investigated a clinically applicable scoring system in determining the risk of esophageal varices in HIV/HCV coinfected patients, that is known as latent portal hypertension leading to esophageal varices.

PATIENTS AND METHODS: Forty-three patients with HIV/HCV coinfection underwent clinical examinations, including endoscopy and assessment of hepatic reserve, in our department between 2009 and 2017. CP score, the recently developed Albumin-Bilirubin (ALBI) grade, and the Albumin-Indocyanine Green Evaluation (ALICE) were compared to evaluate the diagnostic accuracies for the detection of esophageal varices using the Area under the Receiver Operating Characteristic curve (AUROC).

RESULTS: The patients were all male hemophiliacs and were positive for both HIV and HCV antibodies, with a median age of 45 years (range, 29-66 years). Thirty-seven patients (84.1%) were classified as CP A at the examination. The comparison of AUROCs showed a superior diagnostic accuracy for ALICE (AUROC= 0.814) to detect esophageal varices. The positive prediction rate was maximum with ALICE if -2.325 was set, while the negative prediction rate was maximum with ALBI if -2.575 was set. ALICE showed the most accuracy as compared to other 2 scores.

CONCLUSION: ALICE scoring was found to be the most valuable system for portal hypertension in HIV/HCV coinfected hemophilic patients. Because of its high specificity, ALICE for secondary surveillance could be used after other markers such as APRI and FIB-4 indices.