Abstract
People living with HIV/AIDS (PLWHA) are at increased risk of developing portal hypertension, characterized by higher spleen stiffness. This study aimed to evaluate the prevalence of elevated spleen stiffness measurement (SSM) using vibration-controlled transient elastography (VCTE), to explore its associated factors, and to assess its potential role in identifying clinically significant portal hypertension among PLWHA. This prospective cross-sectional study evaluated predictors of clinically significant portal hypertension using SSM and liver stiffness measurement (LSM) performed by VCTE. Participants included two groups: 90 PLWHA and 30 healthy controls. Exclusion criteria included baseline active opportunistic infections, cirrhosis, active alcohol consumption and HBV/HCV. Demographic, biochemical, and ultrasonographic data were collected. SSM ≥ 21 kPa was used as a threshold to screen for clinically significant portal hypertension. Screening for high-risk esophageal varices was conducted using esophagogastroduodenoscopy among PLWHA with SSM ≥ 21 kPa. Follow-up data were collected to assess the occurrence of portal hypertension-related complications. A total of 120 participants were analyzed (PLWHA: n = 90, controls: n = 30). SSM and LSM values were significantly higher among PLWHA compared with that of controls. In this study, 33 participants-29 (32.2%) in the PLWHA group and 4 (13.3%) in the control group-had SSM ≥ 21 kPa, suggesting a risk of clinically significant portal hypertension (CSPH). None of these patients exhibited high risk esophageal varices on endoscopy. During a median follow-up of 15 (IQR: 13,16) months, no PLWHA developed liver decompensation or other portal hypertension-related complications. In univariable analysis, PLWHA had significantly higher odds of elevated spleen stiffness compared with controls (odds ratio 3.09, p = 0.045). However, in multivariable logistic regression, no factors were significantly associated with elevated SSM. Controlled Attenuation Parameter (CAP) did not differ significantly between PLWHA and controls. However, higher BMI was associated with increased CAP values, with median BMI values of 24.66 kg/m² (IQR: 22.12, 28.34) and 28.91 kg/m² (IQR: 23.43, 30.81) for CAP ranges of 201-300 dB/m and 301-400 dB/m, respectively. The prevalence of elevated SSM, indicating a risk for developing CSPH as assessed by VCTE, was notable among PLWHA but did not correlate with high-risk varices or clinical decompensation over a median 15-month follow-up. SSM thresholds for CSPH in PLWHA using VCTE require further validation, and its potential role as a triage tool for non-NCPH warrants additional study.