000			03046cam a2200169 4500
001			NMDX7899
008			120401t2018 xxu||||| |||| 00| 0 eng d
100			_aSchwenk, A.
240			_aHIV Medicine
245			_aLiver ultrasound to evaluate patients with HIV and hepatitis B/C co-infection: coverage and findings from the UK CHIC Study
260			_c2018
500			_aNMUH Staff Publications
500			_aEMBASE
500			_a19
520			_a<span style="font-size: 10pt;">Background: Liver ultrasonography (US) is frequently used to evaluate HIVpositive patients with abnormal liver function tests (LFTs) or for hepatocellular carcinoma surveillance in selected populations. Coverage rates and findings of liver US in HIV and HBV or HCV coinfected UK cohorts are not known. Methods: HBV or HCV coinfected individuals in the UK CHIC Study were included and followed from latest of: UK CHIC entry, date first known to be HBV or HCV coinfected or 01/01/2004, until last date seen in the dataset. Poisson regression (giving incidence rate ratios (IRR)) assessed rates and predictors of ever having a liver US. Associations between US findings and clinical and demographic factors were examined using logistic regression (giving odds ratios (OR)), with generalised estimating equations to account for repeated measures. Results: 4037 HIV and HBV and/or HCV co-infected individuals were included; 2584 (64%) had HCV and 1596 (39.5%) had HBV infections. 1673 (41%) had 3366 US scans during FU (range 0-16) giving an incidence [95% CI] of 18.3 [17.6, 18.8] US per 100 person-years. Factors associated with undergoing US included HBV coinfection (adjusted IRR [95% CI]=1.2 [1.0, 1.3] vs. HCV), later calendar year (aIRR [95% I]=1.8 [1.5, 2.2] 2009-2011 vs. 2004- 2005), not taking antiretroviral therapy, low CD4 count (aIRR [95% CI]=1.0 [1.0, 1.0] per 50 cells/mm3), detectable viral load (aIRR [95% CI]=0.8 [0.7, 1.0] undetectable viral load vs. detectable), higher ALT (aIRR [95% CI]=1.1 [1.1, 1.1] per 20 U/l) and low serum triglycerides (TGI) (aIRR [95% CI]=0.9 [0.9, 1.0] per mmol/l higher). Of scanned individuals, 18% had steatosis identified and this was observed more frequently in HCV than HBV-infected individuals. Older age (aOR [95% CI]=3.9 [1.7, 9.2] >=50 vs. <30 years), non-black ethnicity, higher ALT (aOR [95% CI]=1.0 (1.0, 1.0) per 20 U/l) and higher TGI (aOR [95% CI]=1.3 [1.2, 1.5] per mmol/l) were independently associated with steatosis. The lowest rate of steatosis was seen in people taking lopinavir when compared to efavirenz (aOR [95% CI]=0.5 [0.3, 0.9]). Conclusion: We observed a low, widely variable rate of liver US in HIV and HBV or HCV coinfected patients that increased over time. US were performed more frequently in those with advanced HIV. Steatosis was identified in 18% of coinfected individuals scanned and was independently associated with ethnicity, age, ALT and TGI. [Conference abstract]</span>
856			_uhttps://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.12614
999			_c76644 _d76644