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Original article
Benefits of rilpivirine for liver stiffness in HIV/HCV-coinfected patients
Beneficios de la rilpivirina para la rigidez hepática en pacientes con coinfección por VIH/VHC
Carmen Busca Arenzanaa,
Corresponding author
carmenbusca@gmail.com

Corresponding author.
, Juan González-Garcíaa, Ana Blas-Garcíab,c, Juan V. Espluguesb,c,d,e, Antonio Olveira Martínf, Maria Luisa Montes Ramíreza
a Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
b Departamento de Fisiología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain
d Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
e FISABIO-Hospital Universitario Dr. Peset, Valencia, Spain
f Unidad Hepatología, Servicio de Gastroenterología, Hospital Universitario La Paz, Madrid, Spain
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      <span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Antiretroviral treatment &#40;ART&#41; and its association with hepatotoxicity resulting from coinfection by hepatotropic viruses and HIV have been widely studied&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> The first-generation nonnucleoside reverse transcriptase inhibitors &#40;NNRTIs&#41; nevirapine and efavirenz &#40;EFV&#41; have traditionally been associated with liver toxicity&#46; In contrast&#44; the second-generation NNRTIs etravirine and rilpivirine &#40;RPV&#41; have a good hepatic safety profile and are recommended for HIV-infected patients with chronic liver diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Fibrosis is the most defining trait of chronic liver disease&#46; It is characterized by activation of hepatic stellate cells &#40;HSCs&#41; in response to sustained liver damage&#44; which in turn leads to excessive accumulation of extracellular matrix components&#44; disorganization of liver architecture&#44; and loss of function&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> Given that the stage of fibrosis is a major factor in the prognosis of patients with liver disease&#44; amelioration or reversion of fibrosis is a key objective of treatment&#46; However&#44; no specific drugs have been approved for this indication&#44; despite recent advances in knowledge of the cell mechanisms and molecules involved in pathophysiology and the large number of drugs currently under study for various targets&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Basic research based on murine models of chronic liver disease showed RPV to have an antifibrotic and regenerative effect&#46; One study showed the antisteatotic&#44; anti-inflammatory&#44; and antifibrotic roles of RPV in a nutritional model of metabolic dysfunction-associated fatty liver disease based on a fat-rich diet&#44; as well as in fibrosis models induced by various harmful agents&#46; In all cases&#44; the antifibrotic effect of RPV was due to selective induction of apoptosis in activated HSCs via activation of the transcription factor signal transducer and activator of transcription &#40;STAT&#41; 1&#44; as shown in vivo and in vitro in human cells&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> Thus&#44; the present study aimed to analyze the effect of RPV on liver fibrosis by assessing changes in liver stiffness using transient elastography &#40;TE&#41; and to determine whether RPV-based regimens led to improvement&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and setting</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a retrospective study of a group of patients nested in a large cohort of 4009 HIV-infected patients undergoing regular follow-up at a tertiary hospital&#46; The current analysis of our cohort was performed during the first 6 months of 2019&#46; Since tenofovir alafenamide-containing regimens were not approved at our center until late 2018&#44; patients taking this agent were not included in the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">We selected patients with at least 2 TE measurements&#44; the first of which had to be &#62;5&#46;2<span class="elsevierStyleHsp" style=""></span>kPa&#44; in order to confirm that they had liver fibrosis&#46; This cut-off value was validated in a systematic review with meta-analyses as the best for identifying subjects with fibrosis &#40;any grade&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> RPV-exposed patients &#40;REP&#41; had to have initiated treatment with RPV between the 2 TE measurements&#46; Non-RPV-exposed patients &#40;NREP&#41; had not been exposed to RPV before or during the period between the 2 measurements&#46; The time between the 2 TE measurements had to be at least 24 months&#46; The exclusion criteria were history of alcohol abuse&#44; regular consumption of drugs of abuse&#44; drug-induced acute hepatitis&#44; and HBV or HCV infection after the first TE measurement&#46; Cases and controls were matched using the statistical program SPSS&#46; NREP were matched 1&#58;1 with REP by age &#40;&#177;3 years&#41;&#44; time between TE measurements &#40;&#177;6 months&#41;&#44; time since diagnosis of HIV infection &#40;&#177;3 years&#41;&#44; and coinfection by HCV&#46; The analysis included 118 REP and 118 NREP&#44; thus enabling us to detect&#44; with a confidence level of 95&#37; and a power of 85&#37;&#44; a difference in the final TE over baseline &#62;1&#46;3<span class="elsevierStyleHsp" style=""></span>kPa&#44; assuming a standard deviation of the difference of 4&#46;7<span class="elsevierStyleHsp" style=""></span>kPa&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This study was reviewed and approved by the Ethics Committee for Clinical Research of La Paz University Hospital &#40;C&#46;E&#46;I&#46;C&#46;&#41; as a research project entitled&#58; &#8220;Retrospective longitudinal descriptive registry of naive patients included in the cohort of patients with HIV infection at Hospital La Paz &#40;Madrid&#41;&#8221;&#46; HIV-La Paz cohort&#46; HULP code&#58; PI-890&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variable and measurements</span><p id="par0035" class="elsevierStylePara elsevierViewall">For each patient&#44; we recorded demographic data&#44; anthropometric data &#40;body mass index &#91;BMI&#93;&#41;&#44; data on HBV and HCV coinfection&#44; antiretroviral treatments by family at baseline and at the end of the study&#44; and the changes observed during the period between TE measurements&#46; We analyzed patients who had been exposed to EFV and raltegravir &#40;RAL&#41;&#44; taking into account&#44; respectively&#44; the poor and favorable hepatic safety profile of these agents&#46; We also recorded HCV status&#44; sustained virological response &#40;SVR&#41;&#44; time since SVR&#44; and time from SVR to TE measurement&#46; Liver steatosis was diagnosed using an easily accessible&#44; non-invasive serum biomarker&#44; namely&#44; the triglyceride and glucose index &#40;TyG&#41;&#44; calculated as Ln &#91;triglycerides&#42;glucose&#47;2&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> The HIV-related variables were as follows&#58; time since diagnosis of HIV&#44; exposure to RPV&#44; duration of exposure to RPV&#44; and time from baseline TE to initiation of RPV&#46; The TE measurement was expressed in kilopascals &#40;kPa&#41; as the median of 10 successful acquisitions&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">TE was performed under fasting conditions using a FibroScan device &#40;Probe M&#44; FS402&#59; Echosens&#44; France&#41;&#46; An experienced operator performed TE according to the manufacturer&#39;s protocol&#46; An unreliable measurement was defined as an IQR&#47;TE of 30&#37;&#46; Although the FibroScan device used was able to determine the CAP value&#44; some patients underwent their first liver stiffness assessment with an older device that was not able to assess CAP&#46; In order to avoid the bias arising from use of different diagnostic methods&#44; we decided not to base diagnosis of steatosis on CAP values&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Categorical variables were expressed as percentages&#59; continuous variables were expressed as median and interquartile range &#40;IQR&#41;&#46; Continuous variables were analyzed using the <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney test&#44; depending on the normality of the distribution &#40;Kolmogorov&#8211;Smirnov test with a Lilliefors correction&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Changes in TE were assessed using a general linear model&#44; which provides a repeated-measures analysis of variance&#44; contrasts the effects of intrapatient and interpatient factors&#44; and includes the covariate effect&#46; Baseline and final TE were assessed based on intrapatient factors&#44; exposure to RPV and HCV coinfection as interpatient factors and the nadir CD4 value&#44; length of HIV infection&#44; time between TE measurements&#44; and final BMI as covariates&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Erroneous and non-recoverable data were not imputed and are considered lost&#46; The statistical analysis was performed using SPSS 25&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41;&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 &#40;2-sided&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 822 patients fulfilled the inclusion&#47;exclusion criteria &#40;195 REP&#44; 627 NREP&#41;&#59; of these&#44; 451 were HCV-positive &#40;diagnosed before the first TE measurement&#41;&#44; and 371 were not&#46; After the matching procedure&#44; a total of 236 patients were included in the study&#58; 118 REP and 118 NREP&#46; In the REP group&#44; most patients &#40;more than 70&#37;&#41; had taken RPV for more than 1 year&#44; and the median time between TE measurements was 51 &#40;29&#8211;68&#41; months &#40;at least 24 months between TE measurements&#41;&#44; with no differences between the groups&#46; There were no significant differences between the groups for male sex &#40;REP 86&#37;&#44; NREP 84&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#93;&#41;&#44; intravenous drug use as the route of transmission &#40;REP 40&#37;&#44; NREP 47&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#93;&#41;&#44; CDC stage C &#40;REP 23&#37;&#44; NREP 33&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#93;&#41;&#44; undetectable HIV viral load &#40;REP 88&#37;&#44; NREP 81&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#93;&#41;&#44; HBV coinfection &#40;REP 9&#37;&#44; NREP 12&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#93;&#41;&#44; anti-HBV medication &#40;REP 100&#37;&#44; NREP 100&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#93;&#41;&#44; HCV coinfection &#40;REP 52&#37;&#44; NREP 52&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#93;&#41;&#44; percentage of patients treated &#40;REP 80&#37;&#44; NREP 71&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#93;&#41;&#44; or percentage cured of HCV infection &#40;REP 91&#37;&#44; NREP 98&#37; &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;2&#93;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows quantitative variables for both groups at baseline &#40;i&#46;e&#46;&#44; first TE measurement&#41; and at the end of the study &#40;i&#46;e&#46;&#44; second TE measurement&#41;&#46; Only the median nadir CD4 count was significantly lower in REP&#44; probably due to the recommendations not to use RPV-based regimens as initial treatment for patients with a CD4 cell count below 200&#47;mm<span class="elsevierStyleSup">3</span>&#46; Therefore&#44; median nadir CD4 was included as a covariate in the adjusted regression model&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">We observed a significant reduction in the TE value of &#8722;0&#46;8<span class="elsevierStyleHsp" style=""></span>kPa in NREP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;254&#41; and &#8722;1&#46;6<span class="elsevierStyleHsp" style=""></span>kPa in REP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; this was adjusted for years since diagnosis of HIV infection&#44; time between TE measurements&#44; nadir CD4&#44; and baseline and end-of-study alanine aminotransferase and BMI&#46; Analysis of changes in TE between patients who were and were not coinfected by HCV revealed a significant difference for HCV-coinfected patients only in REP &#40;&#8722;2&#46;3<span class="elsevierStyleHsp" style=""></span>kPa&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Analysis of the changes in TE between patients depending on cure of HCV infection revealed a significant difference in cured patients &#40;REP&#44; &#8722;2&#46;8<span class="elsevierStyleHsp" style=""></span>kPa &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#93;&#59; NREP &#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>kPa &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#93;&#41;&#46; We did not observe significant changes in the remaining subgroups&#44; the subgroups not coinfected with HCV&#44; or in the subgroups of patients not cured of HCV coinfection &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; There was no linear relationship between the time of exposure to RPV and the change in TE values&#46; We analyzed the percentage change in TE as a function of different durations of exposure to RPV &#40;\n
      &lt;!--&#8805;12 months, &lt;/&#8805;24 months, &lt;/&#8805;36 months) and observed no significant differences compared with patients exposed for longer periods.--&gt;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Analysis of the treatment patients were receiving at the time of the first TE scan by family showed that they were not similar &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Exposure to EFV &#40;owing to its poor liver safety profile&#41; and RAL &#40;owing to its favorable liver safety profile&#41; were analyzed specifically&#46; We found no differences for exposure to RAL&#46; The percentage of patients exposed&#47;not exposed to EFV during follow-up did not differ significantly between cases and controls &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;135&#41;&#46; The percentage of patients who interrupted EFV during follow-up was greater in the REP group &#40;39&#37; vs 14&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; In order to analyze whether discontinuation of EFV was more responsible for the reduced TE value than RPV&#44; we ran the same GLM model on the subgroups of patients who interrupted EFV during follow-up and patients not exposed to EFV during follow-up &#40;this was not possible in the subgroup of patients who did not interrupt EFV&#44; because all patients in the REP group interrupted EFV&#41;&#46; The results show that in both subgroups&#44; the reduction in the TE value was significantly greater in REP &#40;&#8722;1&#46;6 &#91;95&#37; CI &#8722;2&#46;4 to &#8722;0&#46;8&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; than in NREP &#40;&#8722;0&#46;8 &#91;95&#37; CI &#8722;1&#46;6 to 0&#46;2&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#46; The magnitude of this change was similar to that observed in the overall sample &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">In order to better understand the reduction in TE measurement among NREP and non-HCV-infected patients&#44; we analyzed the proportion of EFV interruptions among NREP and their HCV status&#59; no significant difference were found &#40;HCV with no EFV interruptions&#44; 47&#46;6&#37; vs HCV with EFV interruptions&#44; 46&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; No differences were found for changes in ART by family between baseline and the end of the study in the non-HCV-infected subgroup compared with the other groups&#46; &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Supplementary Material</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The analysis of the proportion of patients cured of HCV and exposed to RPV who changed fibrosis stage by TE revealed a higher proportion of patients who did not change or improved and a lower proportion of those who worsened&#46; This difference was close to significance &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;066&#41;&#46; If the analysis is performed by comparing patients whose reduction in TE measurement was greater than 33&#37;&#44; this proportion among REP was 31&#37; compared with 16&#46;4&#37; among NREP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;056&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study shows that liver stiffness was lower in treated HIV-infected patients cured of HCV infection who received an RPV-based ART regimen than in those who received other types of ART over a mean exposure period of 28 months&#46; To our knowledge&#44; this is the first report of such an effect associated with an ART regimen based on RPV in HIV-infected patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Elimination of HCV has a beneficial effect on liver stiffness&#44; as demonstrated by the results of our study and those of other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; our results reflect a greater reduction in liver stiffness with exposure to RPV&#44; a proven long-term predictor of better liver outcomes&#46; This reduction was mainly observed in HCV-coinfected patients who were cured&#44; after adjustment for the main HIV-related factors&#44; BMI&#44; and time of exposure to RPV&#46; In the subanalysis focusing on changes in TE stages and percentage reduction in the TE value&#44; the reduction in liver stiffness tended to be greater in REP&#44; although the differences were not statistically significant&#44; probably owing to insufficient statistical power&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Recent experimental data indicate that administration of RPV reduces fibrosis and progression of liver disease&#44; irrespective of etiology&#46; Signaling via the Janus kinase &#40;JAK&#41;-STAT-1 and JAK-STAT-3 pathways regulates liver regeneration and fibrosis&#46; RPV could play a key role in this process via specific and selective STAT-1-mediated induction of apoptosis in HSCs&#44; which release interleukin 6 and normalize STAT-3 in hepatocytes&#44; thus favoring liver regeneration after chronic injury&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> This novel approach could prove highly effective for attenuating liver fibrosis and promoting hepatocyte regeneration in patients with liver damage&#46; In fact&#44; we found the greatest effect in the group of patients with chronic hepatitis C&#44; because liver disease was more frequent in this group&#44; and&#44; therefore&#44; as HSCs were more frequently activated&#44; the effects of RPV on STAT-1 signaling pathways may have been more evident&#46; The changes observed in patients who were not cured of hepatitis C and whose liver stiffness worsened suggest that liver damage secondary to chronic HCV infection is greater than the potential benefit of RPV&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The point from which RPV can exert its antifibrotic effect is unknown&#46; However&#44; taking into account previous studies on regression of liver fibrosis in HIV&#47;HCV-coinfected patients and recent clinical trials with new antifibrotic drugs&#44; regression of fibrosis was observed from 16-18 months after SVR or after starting antifibrotic treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> Therefore&#44; we set the time between TE measurements to be at least 24 months&#46; Our results did not show a linear relationship between time of exposure to RPV and change in TE findings or in differences in the percentage of change in TE values by percentile&#46; We believe that these results reinforce the observation that differences in RPV exposure times would not bias the conclusions of the study&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although we observed a reduction in liver stiffness in non-HCV-infected patients &#40;REP and NREP&#41;&#44; this reduction was not significant&#44; and this finding does not seem to be due to the effect of antiretroviral treatment or liver steatosis&#46; In NREP&#44; it could be associated with changes to regimens based on integrase inhibitors&#44; mainly RAL&#44; which have proven to reduce steatosis &#40;as measured by the CAP&#41; and favor a reduction in liver stiffness&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">11&#44;12</span></a> However&#44; application of a noninvasive serum marker&#44; TyG&#44; at baseline and at the end of the study to estimate liver steatosis did not reveal significant changes in either group&#46; We analyzed the hypothetical impact of switching ART in this subgroup of patients&#46; Again&#44; we found no differences in changes in ART by family between baseline and the end of the study&#46; Thus&#44; it seems unlikely that the impact of switching ART on the greater reduction in the TE value could differ between non-HCV-infected individuals and others&#46; Another potential explanation for the improvement in liver stiffness in non-HCV-coinfected patients could be the impact of four years of hepatitis B treatment in those with chronic hepatitis B&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> The observed effect on liver stiffness is maintained despite the adjustments made for other metabolic or clinically relevant inflammatory variables &#40;such as BMI or alanine aminotransferase&#41; included in the model of analysis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our study is limited by its retrospective design&#46; Other uncontrolled covariates may be present despite our criteria for matching REP and NREP&#44; and the analysis of means adjusted for covariates considerably affected liver fibrosis&#46; Although heavy drinkers and regular drug users were excluded&#44; light or moderate consumption of these toxic substances could not be controlled for&#46; We highlight the low proportion of women included in the study cohort and the lack of evidence to generalize our conclusions to this population&#46; However&#44; given that the ratio of males to females in our clinic is 5&#58;1&#44; this cannot be considered an exclusion bias&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">RPV is widely used in HIV-infected patients&#46; It is very effective and well tolerated&#44; with little liver or lipid toxicity&#46; Data from clinical trials highlight its hepatic safety profile&#44; and&#44; to date&#44; no cases of clinical hepatitis have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14&#8211;19</span></a> Therefore&#44; RPV is a drug of choice in patients with chronic liver disease&#46; It would also be very interesting if it could help to improve liver fibrosis and thus reduce both the progression of chronic liver disease and its consequences&#46; Improvement in liver stiffness has been associated with reduced frequency of decompensation&#44; hepatocarcinoma&#44; and liver-related and non-liver-related mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20&#44;21</span></a> The use of RPV-based therapy in HIV-infected patients could help to reduce the burden of surveillance programs for specific liver complications&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Our results show that administration of RPV-based ART to treat HIV&#47;HCV-coinfected patients with chronic hepatitis C cured&#44; is associated with a greater reduction in liver stiffness&#46; Until further data are available&#44; our results could support a role for RPV in liver regeneration&#44; in addition to its antiretroviral effect&#46; Further studies with different designs are needed to confirm the long-term impact of RPV-based ART on reducing liver stiffness&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">None to declare&#46;</p></span></span>
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    "fechaRecibido" => "2022-03-17"
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            1 => "Liver stiffness"
            2 => "HIV"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rilpivirine &#40;RPV&#41; is an antiretroviral drug characterized by good tolerability and a favorable liver safety profile&#46; Recent research has shown that RPV ameliorates liver fibrosis in animal models of various chronic liver diseases&#46; Our study aimed to analyze the effect of RPV on liver fibrosis by assessing changes in liver stiffness using transient elastography&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective cohort study of HIV-infected patients who were exposed and not exposed to RPV&#46; The change in liver stiffness during the period between two transient elastography measurements was analyzed and compared for patients exposed and not exposed to RPV&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We selected 118 RPV-exposed and 118 non-RPV-exposed HIV-infected patients&#46; Median time between transient elastography &#40;TE&#41; measurements was 50 &#40;29&#8211;68&#41; months&#46; A repeated-measures general linear model based on the main clinical characteristics revealed a significant decrease in the TE value of &#8722;0&#46;8<span class="elsevierStyleHsp" style=""></span>kPa in non-RPV-exposed patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;254&#41; and &#8722;1&#46;6<span class="elsevierStyleHsp" style=""></span>kPa in the RPV-exposed group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The subgroup analysis showed a significant reduction in the TE value only patients cured of hepatitis C &#40;RPV-exposed&#44; &#8722;2&#46;8<span class="elsevierStyleHsp" style=""></span>kPa &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#93;&#59; non-RPV-exposed&#44; &#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>kPa &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#93;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">RPV-based antiretroviral regimens significantly reduced liver stiffness&#44; as measured by TE&#44; in patients cured of chronic hepatitis C&#46;</p></span>"
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            "identificador" => "abst0005"
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            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "identificador" => "abst0015"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La rilpivirina &#40;RPV&#41; es un f&#225;rmaco antirretroviral caracterizado por una buena tolerabilidad y un perfil de seguridad hep&#225;tica favorable&#46; Las &#250;ltimas investigaciones han mostrado que la RPV mejora la fibrosis hep&#225;tica en modelos animales de varias enfermedades hep&#225;ticas cr&#243;nicas&#46; Nuestro estudio ten&#237;a como objetivo analizar el efecto de la RPV en la fibrosis hep&#225;tica mediante la evaluaci&#243;n de cambios en la rigidez hep&#225;tica utilizando una elastograf&#237;a transitoria&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo de pacientes infectados por VIH expuestos y no expuestos a RPV&#46; Se analiz&#243; el cambio en la rigidez hep&#225;tica durante el per&#237;odo entre dos mediciones mediante elastograf&#237;a transitoria y se compar&#243; entre pacientes expuestos y no expuestos a RPV&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Seleccionamos a 118 pacientes infectados por VIH expuestos a RPV y 118 pacientes infectados por VIH no expuestos a RPV&#46; La mediana del tiempo entre las mediciones mediante elastograf&#237;a transitoria &#40;ET&#41; fue de 50 &#40;29-68&#41; meses&#46; Un modelo lineal general de medidas repetidas basado en las principales caracter&#237;sticas cl&#237;nicas revel&#243; una reducci&#243;n significativa en el valor de ET&#44; &#8722;0&#44;8<span class="elsevierStyleHsp" style=""></span>kPa en el grupo de pacientes no expuestos a RPV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;254&#41; y de &#8722;1&#44;6<span class="elsevierStyleHsp" style=""></span>kPa en el grupo de pacientes expuestos a RPV &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El an&#225;lisis de subgrupos mostr&#243; una reducci&#243;n significativa en el valor de ET solo en pacientes curados de hepatitis C &#40;expuestos a RPV&#44; &#8722;2&#44;8<span class="elsevierStyleHsp" style=""></span>kPa &#91;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#93;&#59; no expuestos a RPV&#44; &#8722;1&#44;1<span class="elsevierStyleHsp" style=""></span>kPa &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;22&#93;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las pautas antirretrovirales basadas en RPV redujeron significativamente la rigidez hep&#225;tica&#44; evaluada por las mediciones de ET&#44; en los pacientes que se hab&#237;an curado de hepatitis C cr&#243;nica&#46;</p></span>"
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            "identificador" => "abst0025"
            "titulo" => "Antecedentes"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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          0 => array:4 [
            "apendice" => "<p id="par0150" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0060"
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        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2452
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Change in transient elastography fibrosis stage&#46; &#40;B&#41; Percentage reduction in transient elastography&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">NREP&#58; non-rilpivirine-exposed patients&#59; REP&#58; rilpivirine-exposed patients&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TE IQR&#47;median &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;2 &#40;12&#46;5&#59; 25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">18&#46;3 &#40;13&#46;1&#59; 25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>TE &#40;kPa&#41; &#60;7&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;64&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;66&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>TE &#40;kPa&#41; 7&#46;9&#8211;9&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;16&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>TE &#40;kPa&#41; &#8805;9&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">AST &#40;IU&#47;L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;0 &#40;26&#46;0&#59; 49&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;0 &#40;26&#46;0&#59; 48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ALT &#40;IU&#47;L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;0 &#40;27&#46;0&#59; 59&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;0 &#40;28&#46;0&#59; 64&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">GGT &#40;IU&#47;L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;5 &#40;30&#46;0&#59; 92&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;0 &#40;30&#46;0&#59; 99&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6 &#40;22&#46;0&#59; 28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;4 &#40;22&#46;3&#59; 27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Liver steatosis by TyG &#40;&#62;8&#46;38&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;71&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;76&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Liver steatosis by TyG</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;7 &#40;8&#46;3&#8211;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;8 &#40;8&#46;4&#8211;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Months from baseline TE to starting RPV</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;3 &#40;7&#46;1&#59; 25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">End of study</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TE &#40;kPa&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2 &#40;5&#46;1&#59; 8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;6 &#40;4&#46;9&#59; 7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TE IQR &#40;kPa&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;7&#59; 1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;1 &#40;0&#46;7&#59; 1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TE IQR&#47;median &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2 &#40;11&#46;5&#59; 22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;9 &#40;10&#46;3&#59; 22&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>TE &#40;kPa&#41; &#60;7&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;70&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>TE &#40;kPa&#41; 7&#46;9&#8211;9&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">AST &#40;IU&#47;L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&#46;0 &#40;22&#46;0&#59; 37&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ALT &#40;IU&#47;L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#46;0 &#40;22&#46;0&#59; 52&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">GGT &#40;IU&#47;L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Liver steatosis by TyG &#40;&#62;8&#46;38&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Months from SVR to TE</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="6" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimated marginal means&#42;</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upp&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upp&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;441&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="12" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="12" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Not exposed to EFV during follow-up</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Control&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;4&nbsp;\t\t\t\t\t\t\n
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0130" class="elsevierStylePara elsevierViewall">We acknowledge Ana Delgado as data manager and Luc&#237;a Serrano for the statistical analysis&#46; We acknowledge Mr&#46; Thomas O&#8217;Boyle for translation of the manuscript into English&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">This work was supported by grants from <span class="elsevierStyleGrantSponsor" id="gs1">Instituto de Salud Carlos III</span> &#40;ISCIII&#59; grant number <span class="elsevierStyleGrantNumber" refid="gs1">PI17&#47;01218</span> as part of the Plan Nacional R &#43; D &#43; I&#41; and was cofunded by the ISCIII&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The funders had no role in study design&#44; data collection and analysis&#44; decision to publish&#44; or preparation manuscript&#46;</p>"
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ISSN: 2529993X
Original language: English
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