AST-to-Platelet Ratio Index May Predict Liver-Related Mortality in HIV-Viral Hepatitis Coinfection

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Longitudinal use of the AST-to-platelet ratio index may predict liver-related death in men with viral hepatitis and HIV coinfection.
Longitudinal use of the AST-to-platelet ratio index may predict liver-related death in men with viral hepatitis and HIV coinfection.

Longitudinal use of the aspartate aminotransferase (AST)-to-platelet ratio index may predict liver-related death in men with viral hepatitis and HIV coinfection, according to a recent study published in AIDS.

Researchers conducted a nested case control study to evaluate the relationship between AST-to-platelet ratio index and liver-related adverse events. They retrospectively evaluated patients with viral hepatitis and matched controls for 9 years prior to a liver-related death.

The AST-to-platelet ratio index was calculated at time points of 9, 6, 3, 2, and 1 year prior to patient death and time matched for controls. Time points were grouped into 9 years to >3 years prior to death and 3 years to 1 year prior to death for evaluation purposes.

Of the 57 patients, 91% were diagnosed with both viral hepatitis and HIV. The number of patients with an AST-to-platelet ratio index greater than 1.5 increased during the follow-up time frame from 31% to 75%, and patients had a higher index score at all time points when compared to controls.

Between years 9 and 3, the patients' AST-to-platelet ratio index rose 4.6% each year (P =.1) and between 3 years and 1 year, it rose 30% per year (P <.001). The amount of change from years 9 to 3 and years 3 to 1 was statically significant (P =.01). Lower CD4 counts were associated with a higher AST-to-platelet ratio index.

In conclusion, an increase in AST-to-platelet ratio index appears to be related to a worsening hepatic function. This ratio could be used to assess liver mortality and impending deterioration as early as 3 years prior to death in male patients with viral hepatitis and HIV. These findings could indicate the most at-risk patients and help clinicians select an aggressive treatment protocol.

This study was supported by the National Center for Research Resources and the National Institute on Drug Abuse. Please refer to reference for a complete list of authors' disclosures.


Reference

Price JC, Seaberg EC, Stosor V, WittMD, Lellock CD, Thio CL. AST-to-platelet ratio index increases significantly 3 years prior to liver-related death in HIV-hepatitis-coinfected men [published online Aug. 8, 2018]. AIDS. doi: 10.1097/QAD.0000000000001977

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