1. Evaluation of risk for esophageal varices by transient elastometry in patients with HIV and HCV infection and liver cirrhosis M.K. Mausolf 1, M. Berger 1, J. Breitkreutz 1, J. Hartikainen 1, U. Joppek 1, H. Schulbin 1, H. Stocker 1, C. Traeder 1, C. Weber 1, T. Weipert 1, K. Arastéh 1, R. Weiss 2, P. Ingiliz 1 Institute(s): 1 Vivantes Auguste-Viktoria-Klinikum Berlin, Gastroenterology and Infectious Diseases, Berlin, Germany, 2 Hematology and Infectious Diseases, Bremen, Germany WEPDB 202:

2. -2- Complications of cirrhosis Chanteloup et al. AASLD Boston 2004 16 EV = 0 EV grade 2 or 3 REV EAD HCC 27495463 kPa 7512 Transient elastometry as a tool to predict complications of cirrhosis?

3. -3- Baseline characteristics of patients with Fibroscan >12.5 kPa 1 and UGI (n=68) Varices (n=17)No varices (n=51)P Age, median years (range)49 (36-70)47 (28-66) Male sex [No. (%)]14 (82)35 (68) Median BMI [kg/m 2 ] (95%-CI)24.5 (22-27)23 (22-26) Median ALT level [IU/mL] (95%-CI) 69 (59-128)66 (65-141) Median GGT level [IU/mL] (95%-CI) 72 (59-137)110 (139-365)0.01 Median bilirubin level [mg/dL] (95%-CI) 0.95 (0.51-2.45)0.73 (0.81-1.47) Median prothrombin time [%] (95%-CI) 73 (63-82)89 (83-96)0.005 Indication HCV monoinfection [No. (%)]6 (35)14 (27) HIV-HCV coinfection [No. (%)] 7 (41)24 (47) Miscellanous [No. (%)]4 (24)13 (26) Mean liver stiffness in kPa (+/- SD) 43 (21)28 (19)<0.01 Median liver stiffness in kPa (95%-CI) 36 (32-54)19 (23-34) 1 Castera L, et al. Gastroenterology 2005;128:343–350

4. -4- Significantly higher stiffness values in patients with varices Esophageal varices No varices p<0.01 36 19

5. -5- Are values >36 kPa predictive for the presence of varices? Sensitivity47% Specificity75% PPV0.38 NPV0.81

6. -6- Are values <19 kPa predictive for the absence of varices? Sensitivity51% Specificity94% PPV0.96 NPV0.39

7. -7- Conclusions In cirrhotic patients (stiffness >12.5 kPa) transient elastometry indicates the presence of esophageal varices by higher values („the higher, the stiffer“) HCV infected and HIV/HCV coinfected patients with esophageal varices had median stiffness values of 36 kPa Fibroscan cannot replace gastroscopy for the diagnosis of varices Stiffness values <19 kPa strongly indicate the absence of esophageal varices

8. -8- Thank you for your attention!

9. -9- back-up slides

10. -10- ROC curve