Correlation of transient elastography with APRI and FIB‐4 in a cohort of patients with congenital bleeding disorders and HCV or HIV/HCV coinfection

Abstract

Patients with inherited bleeding disorders frequently suffer from chronic hepatitis C virus (HCV) mono- or human immunodeficiency virus (HIV)/HCV coinfection. Non-invasive markers for liver fibrosis are warranted for these patients. We tested a large cohort of haemophilic patients with HCV mono- or HIV/HCV coinfection for correlation of transient elastography (TE) with two simple surrogate markers of liver fibrosis and for differences in fibrosis stages according to these markers. We prospectively enrolled HCV-positive patients with congenital bleeding disorders with or without HIV coinfection. Liver function tests and platelet counts were determined and TE was performed. Aspartate aminotransferase-to-platelet ratio index (APRI) and a simple index called FIB-4 were calculated and results were correlated with TE. A total number of 174 patients were included (23% HCV, 36% HIV/HCV coinfected, 33% with cleared HCV and 8% with ongoing HIV but cleared HCV). TE correlated significantly with APRI and FIB-4 (r = 0.60; P < 0.001 and r = 0.54; P < 0.001 respectively). This correlation was pronounced in patients with ongoing HCV infection (r = 0.67; P < 0.001 and r = 0.60; P < 0.001). Prediction of advanced fibrosis resulted in concordance rates >80% with combinations of TE plus APRI and APRI plus FIB-4. HIV/HCV coinfected patients did not present with advanced fibrosis stages when compared with HCV-monoinfected patients. Combinations of two non-invasive markers may significantly reduce the number of liver biopsies in patients with bleeding disorders and advanced liver fibrosis. Furthermore, our data support previous studies that observed a favourable outcome in patients with HIV/HCV and a preserved immune function in times of highly active antiretroviral therapy.

A Cross-Sectional Epidemiological Study of Chronic HCV Liver Disease Stage in HIV-Coinfected Patients Using Noninvasive Techniques. CoTrans- GEENI Study

“…In line with this, kappa index between these tests confirms their concordance for detection of significant and severe fibrosis. In fact, the degree of concordance between the APRI and Forns indexes and transient elastography for detection of fibrosis could be even greater than that found in our results, based on recent evidence [25,26].…”

UKHCDO guidelines on the management of HCV in patients with hereditary bleeding disorders 2011

“…combined APRI and FIB‐4 assessments in 174 HCV infected haemophilia patients and demonstrated good correlation with the stage of liver disease as determined by Fibroscan score. Again the concordance rates were highest in patients with cirrhosis [14].…”

Noninvasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis C (and Congenital Bleeding Disorders): Where Do We Stand?

“…77 Similar evaluations were conducted with FS, APRI, or FIB-4 in a population of 172 hemophilic patients, starting from the hypothesis that combinations of different markers may overcome the limitations of each test and reduce the numbers of liver biopsies needed. 79 Concordance rates of FS with APRI and APRI with FIB-4 in the prediction of advanced fibrosis were higher than 80% in this cohort of patients. Combination of FS and FIB-4 resulted in lower concordance rates, indicating that this combination may be less reliable.…”