External validation of the PAGE-B score for HCC risk prediction in people living with HIV/HBV coinfection. Journal of Hepatology
Surial et al. assessed the usefulness of PAGE-B to determine the risk of developing hepatocellular carcinoma (HCC) among people with HIV and hepatitis B virus (HBV) coinfection from four large European cohorts of people with HIV. PAGE-B is an easy-to-calculate score (range: 0-25) based on the covariates age, sex, and platelet count, and is widely used to determine the need for HCC screening in individuals with HBV mono-infection.
The study included all individuals with HIV/HBV coinfection who received tenofovir-containing antiretroviral therapy from the ATHENA cohort (Netherlands), the Aquitaine cohort (France), EuroSIDA, and the Swiss HIV Cohort Study (SHCS). Hepatocellular carcinoma cases were identified using standardized case report forms in all cohorts. The prediction model was evaluated by calculating the c-index (with 1.0 indicating the highest and 0.5 indicating the lowest possible accuracy of the predictions) and negative predictive values.
The study included 2’963 individuals with HIV/HBV coinfection; the median age at tenofovir start was 41 years, 16% were female, and 18% were of African origin. 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, 68 HCCs occurred. The c-index was 0.77 (range 0.73-0.80 across multiple imputations), close to the one found in the original derivation study (c-index 0.80). A PAGE-B cut-off of <10 had a negative predictive value for developing an HCC within 5 years of 99.4% and would spare unnecessary HCC screening in 27% of individuals.
Taken together, the present study shows that the PAGE-B score performs well in individuals with HIV/HBV coinfection. In addition, the high negative predictive value of 99.4% in this population indicates that the PAGE-B score is useful to determine the need for HCC screening.