1. External validation of the PAGE-B score for HCC risk prediction in people living with HIV/HBV coinfection
- Author
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Egger, M., Hoffmann, M., Rauch, A., van der Valk, M., Goorhuis, A., Prins, J. M., van Vugt, M., Wit, F. W.M.N., Cornelissen, M. T.E., Jonges, M., Wolthers, K. C., Zaaijer, H. L., Peters, E. J.G., van Agtmael, M. A., Autar, R. S., Laan, L. M., van den Berge, M., Baas, S., van Arkel, A., Pronk, M. J.H., Alers, W., Nobel, H., Berrevoets, M. A.H., Brouwer, A. E., Rokx, C., Anas, A. A., Bax, H. I., van Gorp, E. C.M., van Nood, E., Nouwen, J. L., Rijnders, B. J.A., Schurink, C. A.M., Slobbe, L., de Vries-Sluijs, T. E.M.S., Bassant, N., van Beek, J. E.A., Vriesde, M., van Zonneveld, L. M., de Groot, J., van Kampen, J. J.A., Koopmans, M. P.G., Rahamat-Langendoen, J. C., Douma, R. A., Schippers, E. F., Gelinck, L. B.S., Mollema, F., Nguyen, T., Groeneveld, P. H.P., Lammers, A. J.J., de Boer, M. G.J., Claas, E. C.J., Brouwer, C. J., Mulder, E., Smit, J. V., van Niekerk, T., Pontesilli, O., van Tienen, C., van Wolfswinkel, M. E., Schippers, J., Kampschreur, L. M., Wagenaar, J., de Regt, M., Schouten, W. E.M., Veenstra, J., Blaauw, H., Knapen, M., Kok, M., Albers, M., de Haan, M., McCall, M., Burger, D., Claassen, M., Hassing, R. J., Verhagen, D. W.M., van Wijk, M., Bakker, M., Postma, D. F., Schenk, H. M., Boonstra, A., de Jonge, H., Niesters, H. G.M., Bruns, A. H.W., Hensgens, M. P.M., Oosterheert, J. J., Verbon, A., Berends, H., Bezemer, D. O., Smit, C., Bergsma, D., Lelivelt, K. J., van de Sande, L., van den Akker, M., Bakker, Y., Bezemer-Goedhart, M., Koster, L. E., Lucas, E. G.A., Schoorl, M. J.C., Witte, E. C.M., Peters, L., Larsen, J. F., Fischer, A. H., Jensen, S. K., Nguyen, D., Garcia, M., Egger, M., Hoffmann, M., Rauch, A., van der Valk, M., Goorhuis, A., Prins, J. M., van Vugt, M., Wit, F. W.M.N., Cornelissen, M. T.E., Jonges, M., Wolthers, K. C., Zaaijer, H. L., Peters, E. J.G., van Agtmael, M. A., Autar, R. S., Laan, L. M., van den Berge, M., Baas, S., van Arkel, A., Pronk, M. J.H., Alers, W., Nobel, H., Berrevoets, M. A.H., Brouwer, A. E., Rokx, C., Anas, A. A., Bax, H. I., van Gorp, E. C.M., van Nood, E., Nouwen, J. L., Rijnders, B. J.A., Schurink, C. A.M., Slobbe, L., de Vries-Sluijs, T. E.M.S., Bassant, N., van Beek, J. E.A., Vriesde, M., van Zonneveld, L. M., de Groot, J., van Kampen, J. J.A., Koopmans, M. P.G., Rahamat-Langendoen, J. C., Douma, R. A., Schippers, E. F., Gelinck, L. B.S., Mollema, F., Nguyen, T., Groeneveld, P. H.P., Lammers, A. J.J., de Boer, M. G.J., Claas, E. C.J., Brouwer, C. J., Mulder, E., Smit, J. V., van Niekerk, T., Pontesilli, O., van Tienen, C., van Wolfswinkel, M. E., Schippers, J., Kampschreur, L. M., Wagenaar, J., de Regt, M., Schouten, W. E.M., Veenstra, J., Blaauw, H., Knapen, M., Kok, M., Albers, M., de Haan, M., McCall, M., Burger, D., Claassen, M., Hassing, R. J., Verhagen, D. W.M., van Wijk, M., Bakker, M., Postma, D. F., Schenk, H. M., Boonstra, A., de Jonge, H., Niesters, H. G.M., Bruns, A. H.W., Hensgens, M. P.M., Oosterheert, J. J., Verbon, A., Berends, H., Bezemer, D. O., Smit, C., Bergsma, D., Lelivelt, K. J., van de Sande, L., van den Akker, M., Bakker, Y., Bezemer-Goedhart, M., Koster, L. E., Lucas, E. G.A., Schoorl, M. J.C., Witte, E. C.M., Peters, L., Larsen, J. F., Fischer, A. H., Jensen, S. K., Nguyen, D., and Garcia, M.
- Abstract
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 impl
- Published
- 2023