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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
External validation of the PAGE-B score for HCC risk prediction in people living with HIV/HBV coinfection
Journal of Hepatology, Volume 78, No. 5, Year 2023
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Description
Background & Aims: HBV coinfection is common among people living with HIV (PLWH) and is the most important cause of hepatocellular carcinoma (HCC). While risk prediction tools for HCC have been validated in patients with HBV monoinfection, they have not been evaluated in PLWH. Thus, we performed an external validation of PAGE-B in people with HIV/HBV coinfection. Methods: We included data on PLWH from four European cohorts who were positive for HBsAg and did not have HCC before starting tenofovir. We estimated the predictive performance of PAGE-B for HCC occurrence over 15 years in patients receiving tenofovir-containing antiretroviral therapy. Model discrimination was assessed after multiple imputation using Cox regression with the prognostic index as a covariate, and by calculating Harrell's c-index. Calibration was assessed by comparing our cumulative incidence with the PAGE-B derivation study using Kaplan-Meier curves. Results: In total, 2,963 individuals with HIV/HBV coinfection on tenofovir-containing antiretroviral therapy were included. PAGE-B was <10 in 26.5%, 10–17 in 57.7%, and ≥18 in 15.7% of patients. Within a median follow-up of 9.6 years, HCC occurred in 68 individuals (2.58/1,000 patient-years, 95% CI 2.03–3.27). The regression slope of the prognostic index for developing HCC within 15 years was 0.93 (95% CI 0.61–1.25), and the pooled c-index was 0.77 (range 0.73–0.80), both indicating good model discrimination. The cumulative incidence of HCC was lower in our study compared to the derivation study. A PAGE-B cut-off of <10 had a negative predictive value of 99.4% for the development of HCC within 5 years. Restricting efforts to individuals with a PAGE-B of ≥10 would spare unnecessary HCC screening in 27% of individuals. Conclusions: For individuals with HIV/HBV coinfection, PAGE-B is a valid tool to determine the need for HCC screening. Impact and implications: Chronic HBV infection is the most important cause of hepatocellular carcinoma (HCC) among people living with HIV. Valid risk prediction may enable better targeting of HCC screening efforts to high-risk individuals. We aimed to validate PAGE-B, a risk prediction tool that is based on age, sex, and platelets, in 2,963 individuals with HIV/HBV coinfection who received tenofovir-containing antiretroviral therapy. In the present study, PAGE-B showed good discrimination, adequate calibration, and a cut-off of <10 had a negative predictive value of 99.4% for the development of HCC within 5 years. These results indicate that PAGE-B is a simple and valid risk prediction tool to determine the need for HCC screening among people living with HIV and HBV. © 2023 The Author(s)
Authors & Co-Authors
Surial, Bernard
Switzerland, Bern
University of Bern
Ramírez-Mena, Adrià
Switzerland, Bern
University of Bern
Limacher, Andreas
Switzerland, Bern
University of Bern
Smit, Colette
Netherlands, Amsterdam
Stichting Hiv Monitoring
Mocroft, Amanda J.
Denmark, Copenhagen
Rigshospitalet
United Kingdom, London
University College London
van der Valk, Marc
Netherlands, Amsterdam
Stichting Hiv Monitoring
Netherlands, Amsterdam
Amsterdam Institute for Infection and Immunity
Bonnet, Fabrice
France, Paris
Inserm
France, Talence
Centre Hospitalier Universitaire de Bordeaux
Peters, Lars
Denmark, Copenhagen
Rigshospitalet
Rockstroh, Jürgen Kurt
Germany, Bonn
Universitätsklinikum Bonn
Günthard, Huldrych F.
Switzerland, Zurich
Universitatsspital Zurich
Switzerland, Zurich
Universität Zürich
Berzigotti, Annalisa
Switzerland, Bern
University of Bern
Rauch, Andri
Switzerland, Bern
University of Bern
Wandeler, Gilles
Switzerland, Bern
University of Bern
Abela, Irène Alma
Unknown Affiliation
Aebi-Popp, Karoline
Unknown Affiliation
Anagnostopoulos, Alexia
Unknown Affiliation
Battegay, Manuel
Unknown Affiliation
Bernasconi, Enos
Unknown Affiliation
Braun, Dominique Laurent
Unknown Affiliation
Bucher, Heíner C.C.
Unknown Affiliation
Calmy, Alexandra L.
Unknown Affiliation
Cavassini, Matthias
Unknown Affiliation
Ciuffi, Angela
Unknown Affiliation
Dollenmaier, Guenter
Unknown Affiliation
Egger, Matthias
Unknown Affiliation
Elzi, Luigia
Unknown Affiliation
Fehr, Jan Sven
Unknown Affiliation
Fellay, Jacques
Unknown Affiliation
Furrer, Hansjakob Jackob
Unknown Affiliation
Fux, Christoph Andreas
Unknown Affiliation
Günthard, Huldrych F.
Unknown Affiliation
Haerry, David Hans Ulrich
Unknown Affiliation
Hasse, Barbara Katharina
Unknown Affiliation
Hirsch, Hans H.
Unknown Affiliation
Hoffmann, Matthias
Unknown Affiliation
Huber, Michael J.
Unknown Affiliation
Kahlert, Christian R.
Unknown Affiliation
Kaiser, Laurent K.
Unknown Affiliation
Keiser, Olivia
Unknown Affiliation
Klimkait, Thomas
Unknown Affiliation
Kouyos, Roger D.
Unknown Affiliation
Kovari, Helen
Unknown Affiliation
Kusejko, Katharina
Unknown Affiliation
Labhardt, Niklaus D.
Unknown Affiliation
Marzolini, Catia
Unknown Affiliation
Metzner, Karin Jutta
Unknown Affiliation
Müller, Nicolas J.
Unknown Affiliation
Nemeth, Johannes
Unknown Affiliation
Nicca, Dunja
Unknown Affiliation
Paioni, Paolo
Unknown Affiliation
Pantaleo, Giuseppe P.
Unknown Affiliation
Perreau, Matthieu
Unknown Affiliation
Rauch, Andri
Unknown Affiliation
Salazar-Vizcaya, Luisa
Unknown Affiliation
Schmid, Patrick
Unknown Affiliation
Speck, Roberto F.
Unknown Affiliation
Stöckle, Marcel
Unknown Affiliation
Trkola, Alexandra
Unknown Affiliation
Weisser, Maja
Unknown Affiliation
Yerly, Sabine T.B.D.
Unknown Affiliation
Geerlings, Suzanne Eugenie
Unknown Affiliation
Goorhuis, Abram
Unknown Affiliation
Hovius, Joppe Willem R.
Unknown Affiliation
van der Poll, Tom
Unknown Affiliation
Prins, Jan M.
Unknown Affiliation
van Vugt, Michèle V.
Unknown Affiliation
Wiersinga, Willem Joost
Unknown Affiliation
Wit, Ferdinand W.N.M.
Unknown Affiliation
Back, Nicole K.T.
Unknown Affiliation
Berkhout, Ben
Unknown Affiliation
Cornelissen, Marion T.E.
Unknown Affiliation
Van Houdt, Robin
Unknown Affiliation
Jonges, Marcel
Unknown Affiliation
Jurriaans, Suzanne
Unknown Affiliation
Wolthers, Katja C.
Unknown Affiliation
Zaaijer, Hans L.
Unknown Affiliation
Peters, Edgar J.
Unknown Affiliation
Van Agtmael, Michiel A.
Unknown Affiliation
Autar, R. S.
Unknown Affiliation
Sigaloff, Kim Catherina Eve
Unknown Affiliation
Stegeman, Jan Arend
Unknown Affiliation
Ammerlaan, Heidi S.M.
Unknown Affiliation
Berrevoets, Marvin A.H.
Unknown Affiliation
Brouwer, Annemarie E.
Unknown Affiliation
Rokx, Casper
Unknown Affiliation
Anas, A. A.
Unknown Affiliation
van Gorp, E. C.
Unknown Affiliation
Nouwen, Jan L.
Unknown Affiliation
Rijnders, Bart J.A.
Unknown Affiliation
Koopmans, Marion P.G.
Unknown Affiliation
Rahamat-Langendoen, Janette C.
Unknown Affiliation
van Nieuwkoop, Cees
Unknown Affiliation
Leyten, Eliane Madeleine Sophie
Unknown Affiliation
de Boer, Mark G.J.
Unknown Affiliation
Claas, Eric C.J.
Unknown Affiliation
Wessels, Els
Unknown Affiliation
Pontesilli, Oscar
Unknown Affiliation
van Tienen, Carla
Unknown Affiliation
van Vonderen, Marit G.A.
Unknown Affiliation
Kampschreur, Linda Martine
Unknown Affiliation
Delsing, Corine E.
Unknown Affiliation
Brinkman, Kees
Unknown Affiliation
Stalenhoef, Janneke Evelyne
Unknown Affiliation
van Crevel, Reinout
Unknown Affiliation
van Aerde, Koen J.
Unknown Affiliation
Hoogerwerf, Jacobien J.
Unknown Affiliation
Burger, David Marinus
Unknown Affiliation
Soetekouw, Robert
Unknown Affiliation
Bakker, Margreet E.G.
Unknown Affiliation
Kleinnijenhuis, Johanneke
Unknown Affiliation
Postma, Douwe F.
Unknown Affiliation
Stienstra, Ymkje
Unknown Affiliation
Barth, Roos E.
Unknown Affiliation
Verbon, Annelies
Unknown Affiliation
van Welzen, Berend Joost
Unknown Affiliation
Wensing, Annemarie Marie J.
Unknown Affiliation
Boyd, Anders C.
Unknown Affiliation
Bezemer, Daniela O.
Unknown Affiliation
Hillebregt, Mariska M.J.
Unknown Affiliation
Karpov, Igor Alexandrovich
Unknown Affiliation
Losso, Marcelo Horacio
Unknown Affiliation
Lundgren, Jens Dilling
Unknown Affiliation
Aho, Inka
Unknown Affiliation
Pradier, Christian
Unknown Affiliation
Chkhartishvili, Nikoloz I.
Unknown Affiliation
Matulionytė, Raimonda
Unknown Affiliation
Oprea, Cristiana
Unknown Affiliation
Kowalska, Justyna Dominika
Unknown Affiliation
Begovac, J.
Unknown Affiliation
Miró, José María ª.
Unknown Affiliation
Guaraldi, Giovanni
Unknown Affiliation
Paredes, Roger
Unknown Affiliation
Larsen, Jakob Friis
Unknown Affiliation
Neesgaard, Bastian
Unknown Affiliation
Jaschinski, Nadine
Unknown Affiliation
Raben, Dorthe
Unknown Affiliation
Kristensen, Dennis Karsten
Unknown Affiliation
Elsing, T. W.
Unknown Affiliation
Phillips, Andrew N.
Unknown Affiliation
Cozzi-Lepri, Alessandro
Unknown Affiliation
Pelchen-Matthews, Annegret
Unknown Affiliation
Bellecave, Pantxika
Unknown Affiliation
Blanco, Patrick
Unknown Affiliation
Bonnet, Fabrice
Unknown Affiliation
Gaborieau, Valérie
Unknown Affiliation
Lafon, Marie Édith
Unknown Affiliation
Lazaro, Estibaliz
Unknown Affiliation
Le Moal, Gwénaël L.
Unknown Affiliation
Malvy, Denis Jean Marie
Unknown Affiliation
Petrov-Sanchez, Ventzislava
Unknown Affiliation
Wittkop, Linda
Unknown Affiliation
Morlat, Philippe
Unknown Affiliation
Vandenhende, Marianne
Unknown Affiliation
Desclaux, Arnaud
Unknown Affiliation
Duvignaud, Alexandre
Unknown Affiliation
Nguyen, Duc Bang
Unknown Affiliation
Pistone, Thierry
Unknown Affiliation
Pellegrin, Jean Luc
Unknown Affiliation
Viallard, Jean François
Unknown Affiliation
Thierry-Mieg, Marion
Unknown Affiliation
Tchamgouè, Serge
Unknown Affiliation
Farbos, Sophie
Unknown Affiliation
André, Katell
Unknown Affiliation
Koffi, Joseph
Unknown Affiliation
Béraud, Guillaume
Unknown Affiliation
Catroux, Mélanie
Unknown Affiliation
Garcia, Magali
Unknown Affiliation
Tumiotto, Camille M.
Unknown Affiliation
Diarra, Fousseyni
Unknown Affiliation
Statistics
Citations: 2
Authors: 169
Affiliations: 10
Identifiers
Doi:
10.1016/j.jhep.2022.12.029
ISSN:
01688278
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Study Design
Cohort Study