Comparison of transient elastography and liver biopsy for the assessment of liver fibrosis in HIV/hepatitis C virus-coinfected patients and correlation with noninvasive serum markers

Abstract

Transient elastography (FibroScan) is a novel, rapid and noninvasive technique to assess liver fibrosis. Our objective was to compare transient elastography (TE) and other noninvasive serum indexes as alternatives to liver biopsy in HIV/hepatitis C virus (HCV)-coinfected patients. The fibrosis stage (METAVIR Score), TE, the aspartate aminotransferase-to-platelet ratio index, the Forns fibrosis index, FIB-4 and HGM-2 indexes were assessed in 100 patients between January 2007 and January 2008. The diagnostic values were compared by calculating the area under the receiver operating characteristic curves (AUROCs). Using TE, the AUROC (95% CI) of liver stiffness was 0.80 (0.72-0.89) when discriminating between F <or= 1 and F > 2, 0.93 (0.85-1.00) when discriminating between F <or= 2 and F > 3 and 0.99 (0.97-1.00) when discriminating between F <or= 3 and F4. For the diagnosis of F >or= 3, the AUROCs of TE were significantly higher than those obtained with the other four noninvasive indexes. Based on receiver operating characteristic curves, three cutoff values were chosen to identify F <or= 1 (<7 kPa), F >or= 3 (>or=11 kPa) and F4 (>or=14 kPa). Using these best cutoff scores, the negative predictive value and positive predictive value were 81.1% and 70.2% for the diagnosis of F <or= 1, 96.3% and 60% for the diagnosis of F >or= 3 and 100% and 57.1% for the diagnosis of F4. Thus, Transient elastography accurately predicted liver fibrosis and outperformed other simple noninvasive indexes in HIV/HCV-coinfected patients. Our data suggest that TE is a helpful tool for guiding therapeutic decisions in clinical practice.

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

“…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].…”

Prospective Evaluation of FibroScan for the Diagnosis of Hepatic Fibrosis Compared with Liver Biopsy/AST Platelet Ratio Index and FIB-4 in Patients with Chronic HBV Infection

“…In Sterling's study, the AUROC for the detection of significant fibrosis in patients with HCV/HIV co-infection is 0.737 [7]. However there is very little information regarding the performance of the FIB-4 index for the diagnosis of hepatic fibrosis in patients with chronic HBV infection [31,32]. In the present study, the AUROC for detection of significant fibrosis and cirrhosis in chronic HBV infection patients by FIB-4 was 0.86 and 0.77, respectively.…”

Liver Fibrosis: Causes and Methods of Assessment, A Review

“…In a similar study the effectiveness of the novel FibroScan® was compared to measurement of serum indices as alternatives to liver biopsy in HIV/hepatitis C virus (HCV)-coinfected patients [69]. Their results concluded that transient elastography accurately predicted liver fibrosis as compared to other simple non-invasive indexes in HIV/HCVcoinfected patients.…”