Comparison of non-invasive liver fibrosis biomarkers in HIV/HCV co-infected patients: The fibrovic study – ANRS HC02

Cacoub, Patrice; Carrat, Fabrice; Bédossa, Pierre; Lambert, Jérôme; Pénaranda, Guillaume; Perronne, Christian; Pol, Stanislas; Halfon, Philippe

doi:10.1016/j.jhep.2008.01.025

Cited by 82 publications

(76 citation statements)

References 66 publications

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“…Similarly, diagnostic performances of FT in our population were consistent with those previously reported [46,47]. The fact that FT outperformed APRI in diagnosing significant fibrosis is consistent with the findings of Cacoub et al [46]. Finally, the better diagnostic performance of TE for cirrhosis compared with APRI has already been reported by Sanchez-Conde et al [48].…”

Section: Discussionsupporting

confidence: 92%

“…Diagnostic performances of TE for significant fibrosis and cirrhosis (AUROC 0.87 and 0.92, respectively) were consistent with those reported in meta-analyses [36,42] as well as in HIV/HCV coinfection [43][44][45]. Similarly, diagnostic performances of FT in our population were consistent with those previously reported [46,47]. The fact that FT outperformed APRI in diagnosing significant fibrosis is consistent with the findings of Cacoub et al [46].…”

Section: Discussionsupporting

confidence: 92%

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Comparison of transient elastography (FibroScan), FibroTest, APRI and two algorithms combining these non‐invasive tests for liver fibrosis staging in HIV/HCV coinfected patients: ANRS CO13 HEPAVIH and FIBROSTIC collaboration

et al. 2013

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ObjectivesCombining noninvasive tests increases diagnostic accuracy for staging liver fibrosis in hepatitis C virus (HCV)-infected patients, but this strategy remains to be validated in HIV/HCV coinfection. We compared the performances of transient elastography (TE), Fibrotest (FT), the aspartate aminotransferase-to-platelet ratio index (APRI) and two algorithms combining TE and FT (Castera) or APRI and FT (SAFE) in HIV/HCV coinfection. MethodsOne hundred and sixteen HIV/HCV-coinfected patients (64% male; median age 44 years) enrolled in two French multicentre studies (the HEPAVIH cohort and FIBROSTIC) for whom TE, FT and APRI data were available were included in the study. Diagnostic accuracies for significant fibrosis (METAVIR F ≥ 2) and cirrhosis (F4) were evaluated by measuring the area under the receiver-operating characteristic curve (AUROC) and calculating percentages of correctly classified (CC) patients, taking liver biopsy as a reference. ResultsFor F ≥ 2, both TE and FT (AUROC = 0.87 and 0.85, respectively) had a better diagnostic performance than APRI (AUROC = 0.71; P < 0.005). Although the percentage of CC patients was significantly higher with Castera's algorithm than with SAFE (61.2% vs. 31.9%, respectively; P < 0.0001), this percentage was lower than that for TE (80.2%; P < 0.0001) or FT (73.3%; P < 0.0001) taken separately. For F4, TE (AUROC = 0.92) had a better performance than FT (AUROC = 0.78; P = 0.005) or APRI (AUROC = 0.73; P = 0.025). Although the percentage of CC patients was significantly higher with the SAFE algorithm than with Castera's (76.7% vs. 68.1%, respectively; P < 0.050), it was still lower than that for TE (85.3%; P < 0.033). ConclusionsIn HIV/HCV-coinfected patients, TE and FT have a similar diagnostic accuracy for significant fibrosis, whereas for cirrhosis TE has the best accuracy. The use of the SAFE and Castera algorithms does not seem to improve diagnostic performance. On average, nearly half of patients have developed liver cirrhosis after 25 years of HCV infection. Assessment of liver fibrosis is thus of critical importance in HIV/HCV-coinfected patients not only for prognosis but also for antiviral therapy indications. Indeed, two endpoints are clinically relevant: (i) the presence of significant fibrosis, which is the hallmark of progressive disease and an indication for antiviral treatment; (ii) the presence of cirrhosis, which is an indication for specific monitoring of complications related to portal hypertension and to the increased risk of developing hepatocellular carcinoma [4]. Liver biopsy (LB) is classically considered the gold standard for staging fibrosis [5], although it has several limitations: it is an invasive and painful procedure [6][7][8], with rare but potentially life-threatening complications [9], and prone to sampling errors [10][11][12]. Thus, many patients are reluctant to undergo LB, especially HIV/HCV-coinfected patients who may be discouraged from initiating anti-HCV treatment for this reason.These limitations have stimulated the search fo...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Comparison of transient elastography (FibroScan), FibroTest, APRI and two algorithms combining these non‐invasive tests for liver fibrosis staging in HIV/HCV coinfected patients: ANRS CO13 HEPAVIH and FIBROSTIC collaboration

et al. 2013

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“…A FIB-4 score of less than 1.45 associated with mild fibrosis, METAVIR stage 1 or less whereas a score of greater than 3.25 indicates more advanced disease, METAVIR stage 2 or greater. 11 These categorical cut-points have been examined in several studies, and they have been found to be predictive of fibrosis staging at the extremes of the spectrum. 7,8,[11][12][13][14][15] In this study baseline APRI and FIB-4 were examined by baseline fibrosis score as a dichotomous variable and the change in fibrosis score was examined as a linear variable.…”

Section: Methodsmentioning

confidence: 99%

Change in Fibrosis Score as a Predictor of Mortality Among HIV-Infected Patients with Viral Hepatitis

Jain

Seremba

Bhore

et al. 2012

AIDS Patient Care and STDs

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Noninvasive markers of liver fibrosis, measured at baseline, have been shown to predict liver-related mortality. It remains unknown if a change in the value of the scores over time predicts mortality in patients with HIV and viral hepatitis. In this retrospective study, survival in HIV/hepatitis B virus (HBV; n = 67), HIV/hepatitis C virus (HCV; n = 43), and HIV/HBV/HCV (n = 41) patients was examined using Kaplan-Meier life table analysis. Aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and FIB-4 scores, two noninvasive markers of liver fibrosis, were calculated at baseline and at last available clinical follow-up to determine the change in fibrosis score. Factors associated with mortality were assessed by Cox proportional hazards, including the change in the noninvasive marker score between the two time points. All-cause mortality was determined by Social Security Death Index and chart review. Sixty-seven were coinfected with HIV/HBV, 43 with HIV/HCV, and 41 were triply infected (HIV/HBV/HCV). Kaplan-Meier analysis showed similar survival for the three groups at 7 years of follow-up ( p = 0.10). However, median length of follow-up was lower in HIV/HCV (60.5; range 0-102) compared to HIV/HBV (75.7; 12.3-126.5) and HIV/HBV/HCV (80.0; 2.7-123) months, respectively, p = 0.02. Baseline fibrosis score ( p = 0.002), an increase in the value for noninvasive measurements for fibrosis ( p < 0.001), and the presence of HIV/HCV coinfection ( p = 0.041) were each associated with higher risk for mortality. Baseline fibrosis score ( p = 0.03) and an increase in FIB-4 score ( p = 0.05) were independent predictors of all-cause mortality, but liver-related mortality was not evaluated. In this study, baseline fibrosis score was predictive of 7-year all-cause mortality. Further studies are needed in a prospective cohort to evaluate the predictive value of monitoring changes in fibrosis scores over time to predict mortality in patients with viral hepatitis.

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“…Because his platelet count was over 180,000/μL and the noninvasive biomarkers of liver fibrosis (18,19) did not indicate advanced liver fibrosis [hyaluronic acid: 60.7 μg/L (normal: <50 μg/L), amino-terminal properties of type III collagen: 1.1 U/mL (normal: <1.0 U/mL), type IV collagen 7S: 5.3 ng/mL (normal: <6.0 ng/mL)], the HCV treatment was suspended until direct-acting antivirals (DAAs), which are highly effective, well-tolerated therapies (20), were approved by the Japanese Ministry of Health, Labour and Welfare. Two years after the onset of his primary HCV infection, the patient's liver transaminases were again elevated (ALT 1,100 IU/L, AST 541 IU/L) and the exacerbation of his HCV infection was supported by HCV RNA fluctuations (his HCV load was 6.2 to 7.2 log IU/mL).…”

Section: Case Reportmentioning

confidence: 99%

An Hepatitis C Virus (HCV)/HIV Co-Infected Patient who Developed Severe Hepatitis during Chronic HCV Infection: Sustained Viral Response with Simeprevir Plus Peginterferon-Alpha and Ribavirin

et al. 2015

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We herein describe the case of a 42-year-old man who developed severe hepatitis caused by hepatitis C virus (HCV) infection at 14 years after the start of human immunodeficiency virus (HIV) treatment. Surprisingly, the levels of alanine aminotransferase (ALT) fluctuated, reaching a peak higher than 1,000 IU/L during chronic HCV infection, and the hepatic histology showed advanced liver fibrosis at 3 years after the primary HCV infection. He was treated with simeprevir, peginterferon-alpha, and ribavirin with a sustained viral response. We conclude that HCV/HIV co-infected patients need to commence anti-HCV therapy when the levels of ALT fluctuate severely under successful HIV control.

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Comparison of non-invasive liver fibrosis biomarkers in HIV/HCV co-infected patients: The fibrovic study – ANRS HC02

Cited by 82 publications

References 66 publications

Comparison of transient elastography (FibroScan), FibroTest, APRI and two algorithms combining these non‐invasive tests for liver fibrosis staging in HIV/HCV coinfected patients: ANRS CO13 HEPAVIH and FIBROSTIC collaboration

Comparison of transient elastography (FibroScan), FibroTest, APRI and two algorithms combining these non‐invasive tests for liver fibrosis staging in HIV/HCV coinfected patients: ANRS CO13 HEPAVIH and FIBROSTIC collaboration

Change in Fibrosis Score as a Predictor of Mortality Among HIV-Infected Patients with Viral Hepatitis

An Hepatitis C Virus (HCV)/HIV Co-Infected Patient who Developed Severe Hepatitis during Chronic HCV Infection: Sustained Viral Response with Simeprevir Plus Peginterferon-Alpha and Ribavirin

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