Prediction of Esophageal Varices by Liver Stiffness and Platelets in Persons with HIV infection and Compensated Advanced Chronic Liver Disease.

BACKGROUND: Human immunodeficiency virus (HIV)-infected individuals are at increased risk of cirrhosis and esophageal varices. Baveno VI criteria, based on liver stiffness measurement (LSM) and platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for esophageal varices needing treatment (EVNT). This approach has not been validated in HIV-infected patients. METHODS: HIV-infected patients from eight prospective cohorts were included if they fulfilled the following criteria: 1) compensated advanced chronic liver disease (LSM >10 kPa); 2) availability of EGD within 6 months of reliable LSM. Baveno VI (LSM 150,000), expanded Baveno VI (LSM 110,000) and HEPAVIR criteria (LSM 110,000 and LSM <30 kPa (HIV cirrhosis criteria), with 34.6% EGD spared and 0% EVNT missed. In the validation set, HEPAVIR and HIV cirrhosis criteria spared 54% and 48.7% EGD, while missing 4.9% and 2.2% EVNT, respectively. CONCLUSIONS: Baveno VI criteria can be extended to HEPAVIR and HIV cirrhosis criteria while sparing a significant number of EGD, thus improving resource utilization for HIV-related compensated advanced chronic liver disease.