Viral hepatitis and liver transplantatation
Bibliographic record
Abstract
The etiologies and outcomes of acute liver failure (ALF) in HIV + pts are largely unknown.In addition, the long term outcomes of HIV + pts with ALF undergoing transplantation have not been described.The aim of this study is to describe the presenting features, risk factors, and outcomes of adult HIV + pts with ALF enrolled in the ALFSG.METHODS: Clinical outcomes at 3 weeks of consecutive adult ALF HIV + pts enrolled between 1998 and January 2013 were reviewed and a subgroup returned for a study visit at 1 or 2 years after enrollment.RESULTS: Thirty three of the 2264 ALF pts (1.3%) were HIV +, enrolled at 16 sites.Etiologies of ALF included DILI in 11 (33%), acetaminophen (APAP) overdose in 9 (27%), and the remaining 13 (39%) were due to HBV (4), AIH (4), indeterminate (3), HAV (1), and ischemia (1).The age, gender, and racial distribution of our cohort was similar to that of HIV+ pts in the general US population (2010 CDC HIV Surveillance Report).Twenty two (67%) were male and their mean age was 39.3 +/-12.8yrs; 18 (54%) were Caucasian, 13 (39%) African-American, and 2 (6%) were of other ethnicities.Seven (21%) had HBV co-infection, 2 (6 %) had HCV co-infection, 6 % reported a recent history of alcohol abuse.None had a recent history of IDU; 19/33 (57%) were receiving an antiretroviral agent at study enrollment.RUCAM scores were performed on 14 suspect drugs in the 11 DILI cases that were categorized into: highly probable (1), probable (5), possible (4), and unlikely (4).Implicated agents in the DILI cases included 7 combination antiretroviral agents given for 5-30 days, 2 trimethoprim-sulfamethoxazole cases, and 5 due to other drugs including voriconazole (1), sulfadiazine (2), duloxetine (1), and clarithromycin (1).Twenty four (73%) were alive at 3 weeks including 6 (18%) who had undergone transplantation (2 APAP, 1 DILI, 1 AIH, 1 HBV, 1 HAV).Six of 9 pts that died at 3 weeks were due to DILI.The APAP pts had a 3-week spontaneous survival rate of 78% compared to only 36% in the DILI group.Nine pts were seen at a mean of 26 months after enrollment which included 5 LT recipients (1 APAP, 1 DILI, 3 Other)and 4 spontaneous survivors (2 APAP, 1 DILI, 1 Other).At follow-up, 7 (78%) had normal liver biochemistries and none of the LT recipients had experienced rejection or alloimmune hepatitis.CONCLUSIONS: DILI is over-represented in HIV+ ALF patients in comparison to the overall ALFSG cohort (33% vs 10%), but is not limited to anti-retrovirals.The small number of ALF HIV + LT recipients have generally done well, indicating that LT can be offered to selected HIV+ ALF patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".