Assessment of liver disease (noninvasive methods)

Abstract

Purpose of review The purpose of this review is to highlight new findings published in 2010-11 related to noninvasive fibrosis assessment in HIV/HCV co-infected patients. Overall, in 2010-11, 15 papers were published, of which two were excluded because they were published in languages other than English. Recent findings 11 papers focused on serum marker panels. Papers sought to either 1) validate established panels in HIV/HCV co-infected patients often by comparing multiple serum marker panels in the same population; 2) establish new marker panels using combinations of markers used in previously validated panels; and 3) develop new marker panels using novel methodology. Overall, all panels performed within similar ranges of diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AUROC) but the Fibrometer panel and its derivations achieved the highest performance. Four studies focused on transient elastography (TE). Two papers confirmed its accuracy for identifying fibrosis and cirrhosis and two papers confirmed that misclassification rates are higher in the presence of elevated triglycerides and steatosis. Summary Overall, performance of TE appeared superior to the majority of serum marker panels for the detection of significant fibrosis and cirrhosis in HIV/HCV co-infected patients. Challenges of widespread application of TE remain high misclassification in some subgroups, lack of standardized cutpoints and lack of widespread availability. Panels that were newly developed in 2010-11 specifically for HIV/HCV appeared to perform better than existing panels such as APRI and FIB-4; however additional external validation will be needed to confirm their accuracy.

Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C

“…A simpler and cheaper alternative, the FIB-4 index was advanced about a decade ago, and advocated for use based on reliability as well as widespread availability using values from a patient's comprehensive metabolic panel [13,14]. Consistent with the findings in the literature [25][26][27], the FIB-4 index measurements here were highly correlated with FibroScan results and correctly identified patients with advanced fibrosis in our ED. Notably, in our state Maryland, even though Medicaid provides HCV antiviral treatment coverage to participants with the fibrosis stage of F2 or higher that is determined by liver elastography (FibroScan®) or the commercially available blood index known as HCV FibroSure™ [28], we suggest that FIB-4 would provide a highly practical tool that can be used to prioritize initial referral for services, and once linked to care, additional staging tests could be performed as required for approval of initiation of medical treatment.…”

The risk of hepatocellular carcinoma among individuals with acquired immunodeficiency syndrome in the United States

“…Optimal clinical surveillance methods for HCC in HIV-infected populations need further investigation, for example, characterizing the utility of risk scoring algorithms or noninvasive imaging methods in HCV/HBV-coinfected patients. 40,41 Cost-benefit and cost-effectiveness analyses also will be needed to evaluate the role of surveillance in linking at-risk individuals to early initiation of newer antiviral therapies and identifying appropriate individuals with cirrhosis for liver transplantation. 42,43 In the interim, clinical and public health prevention efforts should continue to focus on reducing the risk of chronic liver disease among HIV-infected Figure 1.…”

Ultrasound Elastography - Review of Techniques and Its Clinical Applications in Pediatrics - Part 1

“…As mentioned above, elastography is one of these noninvasive procedures, being currently in common use in older patients with liver fibrosis due to many pathological conditions e.g. HCV hepatitis [29]. However, the difference between congenital biliary atresia and well-investigated hepatic pathologies (e.g.…”