Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0020104
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dc.titleProgression of biopsy-measured liver fibrosis in untreated patients with hepatitis c infection: Non-markov multistate model analysis
dc.contributor.authorBacchetti P.
dc.contributor.authorBoylan R.
dc.contributor.authorAstemborski J.
dc.contributor.authorShen H.
dc.contributor.authorMehta S.H.
dc.contributor.authorThomas D.L.
dc.contributor.authorTerrault N.A.
dc.contributor.authorMonto A.
dc.date.accessioned2019-11-11T08:40:23Z
dc.date.available2019-11-11T08:40:23Z
dc.date.issued2011
dc.identifier.citationBacchetti P., Boylan R., Astemborski J., Shen H., Mehta S.H., Thomas D.L., Terrault N.A., Monto A. (2011). Progression of biopsy-measured liver fibrosis in untreated patients with hepatitis c infection: Non-markov multistate model analysis. PLoS ONE 6 (5) : e20104. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0020104
dc.identifier.issn19326203
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/162048
dc.description.abstractBackground: Fibrosis stages from liver biopsies reflect liver damage from hepatitis C infection, but analysis is challenging due to their ordered but non-numeric nature, infrequent measurement, misclassification, and unknown infection times. Methods: We used a non-Markov multistate model, accounting for misclassification, with multiple imputation of unknown infection times, applied to 1062 participants of whom 159 had multiple biopsies. Odds ratios (OR) quantified the estimated effects of covariates on progression risk at any given time. Results: Models estimated that progression risk decreased the more time participants had already spent in the current stage, African American race was protective (OR 0.75, 95% confidence interval 0.60 to 0.95, p = 0.018), and older current age increased risk (OR 1.33 per decade, 95% confidence interval 1.15 to 1.54, p = 0.0002). When controlled for current age, older age at infection did not appear to increase risk (OR 0.92 per decade, 95% confidence interval 0.47 to 1.79, p = 0.80). There was a suggestion that co-infection with human immunodeficiency virus increased risk of progression in the era of highly active antiretroviral treatment beginning in 1996 (OR 2.1, 95% confidence interval 0.97 to 4.4, p = 0.059). Other examined risk factors may influence progression risk, but evidence for or against this was weak due to wide confidence intervals. The main results were essentially unchanged using different assumed misclassification rates or imputation of age of infection. Discussion: The analysis avoided problems inherent in simpler methods, supported the previously suspected protective effect of African American race, and suggested that current age rather than age of infection increases risk. Decreasing risk of progression with longer time already spent in a stage was also previously found for post-transplant progression. This could reflect varying disease activity, with recent progression indicating active disease and high risk, while longer time already spent in a stage indicates quiescent disease and low risk. © 2011 Bacchetti et al.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceUnpaywall 20191101
dc.subjectadolescent
dc.subjectadult
dc.subjectAfrican American
dc.subjectage
dc.subjectarticle
dc.subjectcontrolled study
dc.subjectdisease course
dc.subjectfemale
dc.subjecthepatitis C
dc.subjecthigh risk patient
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infection
dc.subjectliver biopsy
dc.subjectliver fibrosis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmixed infection
dc.subjectprotection
dc.subjectrisk factor
dc.subjectaging
dc.subjectbiological model
dc.subjectbiopsy
dc.subjecthepatitis C
dc.subjectliver
dc.subjectliver cirrhosis
dc.subjectmiddle aged
dc.subjectpathology
dc.subjectprobability
dc.subjectsensitivity and specificity
dc.subjecttime
dc.subjectHepatitis C virus
dc.subjectHuman immunodeficiency virus
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAging
dc.subjectBiopsy
dc.subjectDisease Progression
dc.subjectHepatitis C
dc.subjectHumans
dc.subjectLiver
dc.subjectLiver Cirrhosis
dc.subjectMarkov Chains
dc.subjectMiddle Aged
dc.subjectModels, Biological
dc.subjectRisk Factors
dc.subjectSensitivity and Specificity
dc.subjectTime Factors
dc.subjectYoung Adult
dc.typeArticle
dc.contributor.departmentMICROBIOLOGY AND IMMUNOLOGY
dc.description.doi10.1371/journal.pone.0020104
dc.description.sourcetitlePLoS ONE
dc.description.volume6
dc.description.issue5
dc.description.pagee20104
dc.published.statePublished
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