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1. External validation of the PAGE-B score for HCC risk prediction in people living with HIV/HBV coinfection

Author

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

2. Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996-2014: results from a national observational cohort

Author

Op De Coul, Eline L.M., Van Sighem, Ard, Brinkman, Kees, Van Benthem, Birgit H., Van Der Ende, Marchina E., Geerlings, Suzanne, Reiss, Peter, Prins, J. M., Kuijpers, T. W., Scherpbier, H. J., Van Der Meer, J. T.M., Wit, F.W.N.M., Godfried, M. H., Reiss, P., Van Der Poll, T., Nellen, F. J.B., Geerlings, S. E., Van Vugt, M., Pajkrt, D., Bos, J. C., Wiersinga, W. J., Van Der Valk, M., Goorhuis, A., Hovius, J. W., Van Eden, J., Henderiks, A., Van Hes, A. M.H., Mutschelknauss, M., Nobel, H. E., Pijnappel, F. J.J., Westerman, A. M., Jurriaans, S., Back, N. K.T., Zaaijer, H. L., Berkhout, B., Cornelissen, M. T.E., Schinkel, C. J., Thomas, X. V., De Ruyter Ziekenhuis, Admiraal, Van Den Berge, M., Stegeman, A., Baas, S., De Looff, L. Hage, Versteeg, D., Pronk, M. J.H., Ammerlaan, H. S.M., Korsten-Vorstermans, E. M.H.M., De Munnik, E. S., Tjhie, J., Wegdam, M. C.A., Weijsenfeld, A. M., Van Der Ende, M. E., De Vries-Sluijs, T. E.M.S., Van Gorp, E. C.M., Schurink, C. A.M., Nouwen, J. L., Verbon, A., Rijnders, B. J.A., Bax, H. I., Hassing, R. J., Van Der Feltz, M., Bassant, N., Van Beek, J. E.A., Vriesde, M., Van Zonneveld, L. M., De Oude-Lubbers, A., Van Den Berg-Cameron, H. J., Bruinsma-Broekman, F. B., De Groot, J., De Zeeuw-De Man, M., Broekhoven-Kruijne, M. J., Schutten, M., Osterhaus, A. D.M.E., Boucher, C. A.B., Driessen, G. J.A., Van Rossum, A. M.C., Van Der Knaap, L. C., Visser, E., Branger, J., Duijf-Van De Ven, C. J.H.M., Schippers, E. F., Van Nieuwkoop, C., Brimicombe, R. W., VanJperen, J. M., Van Der Hut, G., Franck, P. F.H., Van Eeden, A., Groot, M., Kwa, I. S., Bouwhuis, J. W., Van Hulzen, A. G.W., Bor, P. C.J., Bloembergen, P., Wolfhagen, M. J.H.M., Ruijs, G. J.H.M., Soetekouw, R., Van Der Prijt, L. M.M., Schoemaker, M., Van Der Reijden, W. A., Jansen, R., Herpers, B. L., Kroon, F. P., Arend, S. M., De Boer, M. G.J., Bauer, M. P., Jolink, H., Vollaard, A. M., Moons, C., Kroes, A. C.M., Pogany, K., Smit, J. V., Smit, E., Van Niekerk, T., Pontesilli, O., Lashof, A. Oude, Posthouwer, D., Schippers, J., Vergoossen, R., Loo, I. H., El Moussaoui, R., Van Twillert, G., Stuart, J. W.T.Cohen, Diederen, B. M.W., Van Truijen-Oud, F. A., Gelinck, L. B.S., Meerkerk, C., Wildenbeest, G. S., Jansen, C. L., Van Houte, D. P.F., Faber, S., Delsing, C. E., Heins, H., Frissen, P. H.J., Blok, W. L., Schouten, W. E.M., Van Den Berk, G. E.L., Brouwer, C. J., Geerders, G. F., Hoeksema, K., Kleene, M. J., Van Der Meché, I. B., Toonen, A. J.M., Wijnands, S., Keuter, M., Van Der Ven, A. J.A.M., Hofstede, Hjm Ter, Dofferhoff, A. S.M., Van Crevel, R., Bosch, M. E.W., Grintjes-Huisman, K. J.T., Zomer, B. J., Van Der Berg, J. P., Gisolf, E. H., Van Bentum, P. H.M., Langebeek, N., Swanink, C. M.A., Lettinga, K. D., Sulman, H., Witte, E., Vrouenraets, S. M.E., Lauw, F. N., Paap, H., Vlasblom, D. J., Rosingh, A. W., Brouwer, A. E., Kuipers, M., Santegoets, R. M.W.J., Van Der Ven, B., Buiting, A. G.M., Kabel, P. J., Sprenger, H. G., Scholvinck, E. H., Van Assen, S., Wilting, K. R., Stienstra, Y., Van Der Meulen, P. A., De Weerd, D. A., Riezebos-Brilman, A., Van Leer-Buter, C. C., Schneider, M. M.E., Mudrikova, T., Ellerbroek, P. M., Oosterheert, J. J., Arends, J. E., Barth, R. E., Wassenberg, M. W.M., Laan, L. M., Van Oers-Hazelzet, E. E.B., Patist, J., Vervoort, S., Frauenfelder, R., Verduyn-Lunel, F., Wensing, A. M.J., Van Agtmael, M. A., Perenboom, R. M., Bomers, M., De Vocht, J., Vandenbroucke-Grauls, C. M.J.E., Ang, C. W., Wolfs, T. F.W., Bont, L. J., Gras, L., Van Sighem, A. I., Smit, C., Hillebregt, M., Kimmel, V., Tong, Y., Van Den Boogaard, R., Hoekstra, P., De Lang, A., Berkhout, M., Grivell, S., Jansen, A., Van Den Akker, M., Bergsma, D., Lodewijk, C., Meijering, R., Peeck, B., Raethke, M., Ree, C., Regtop, R., Ruijs, Y., Schoorl, M., Tuijn, E., Veenenberg, L., Woudstra, T., Bakker, Y., De Jong, A., Broekhoven, M., Claessen, E., Rademaker, M. J., Munjishvili, L., Kruijne, E., Other departments, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Infectious diseases, Global Health, Paediatric Infectious Diseases / Rheumatology / Immunology, General Internal Medicine, Center of Experimental and Molecular Medicine, Graduate School, Medical Microbiology and Infection Prevention, Gastroenterology and Hepatology, APH - Health Behaviors & Chronic Diseases, Internal Medicine, Virology, Medical Microbiology & Infectious Diseases, Epidemiology, Pediatric Surgery, Pediatrics, Med Microbiol, Infect Dis & Infect Prev, MUMC+: MA Alg Interne Geneeskunde (9), MUMC+: DA MMI Staf (9), RS: CAPHRI - R4 - Health Inequities and Societal Participation, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, MUMC+: DA Medische Microbiologie en Infectieziekten (5), MUMC+: DA MMI Infectieserologie (9), and MUMC+: DA MMI AIOS (9)

Subjects
Male, Pediatrics, Delayed Diagnosis, Epidemiology, General Practice, Health Behavior, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], HIV Infections, Logistic regression, Cohort Studies, 0302 clinical medicine, Risk Factors, Ethnicity, 030212 general & internal medicine, Young adult, Netherlands, Transients and Migrants, Age Factors, Prenatal Care, General Medicine, Middle Aged, Hospitals, Cohort, Disease Progression, Female, 0305 other medical science, Sexuality, Cohort study, Adult, medicine.medical_specialty, Emigrants and Immigrants, Prenatal care, 03 medical and health sciences, Young Adult, Acquired immunodeficiency syndrome (AIDS), SDG 3 - Good Health and Well-being, medicine, Humans, Socioeconomic status, 030505 public health, business.industry, Research, medicine.disease, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], business, Demography
Abstract

Contains fulltext : 172538.pdf (Publisher’s version ) (Open Access) OBJECTIVES: Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. METHODS: HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. RESULTS: Of 20 965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p /=50 years (1.46; CI 1.33 to 1.60 vs 30-49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. CONCLUSIONS: Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged >/=50 years and certain regions in the Netherlands.

Published
2016
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