Diagnostic accuracy of the APRI, FIB-4, and the Forns index for predicting liver fibrosis in HIV/HCV-coinfected patients: A validation study

Resino, Salvador; Asensio, Cristina; Bellón, José María; Carmona, Rocı́o; Miralles, Pilar; López, Juan Carlos; Cosín, Jaime; Álvarez, E.; Berenguer, Juan

doi:10.1016/j.jinf.2011.07.017

Cited by 16 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HIV coinfection did not influence the relationship between sCD163 and the fibrosis models, which is interesting because FIB-4 was developed for HCV/HIV coinfected patients, 2 and both APRI and FIB-4 have been repeatedly validated in HCV/HIV coinfection. 3,4 These findings suggest that sCD163 may be a good fibrosis marker not only in HCV monoinfection, but also in HCV/HIV coinfection, but this needs validation in coinfected patients with histological data.…”

Section: Replymentioning

confidence: 95%

Reply

Kazankov¹,

Møller²,

Bibby³

et al. 2015

Hepatology

View full text Add to dashboard Cite

monoinfection (N 5 65); (3) HIV monoinfection (N 5 64); and (4) HIV-/HCV-negative controls (N 5 64). 2 We found that sCD163 and Gal-3BP levels were higher in women with versus without HCV, whereas sCD14 levels were elevated in both HIV-and HCV-infected women, compared to controls. 2 Because liver biopsy data are not available for these women, we examined cross-sectional associations of sCD163, sCD14, and Gal-3BP levels with two noninvasive measures of liver fibrosis-aspartate aminotransferase to platelet ratio index (APRI) and FIB-4-calculated as previously described. 3 The data were normalized based on log 2 (sCD163) and log e (APRI and FIB-4) transformations.Plasma sCD163 levels were significantly associated with both APRI and FIB-4 in HCV-monoinfected and HCV/HIV coinfected women (Fig. 1). No significant associations were observed between sCD163 and APRI/FIB-4 in HIV monoinfected women or uninfected controls (data not shown). Furthermore, no significant associations of sCD14 and Gal-3BP were observed with APRI or FIB-4 in any study group (data not shown). The associations of sCD163 with APRI/FIB-4 in women with HCV remained statistically significant after adjustment for age, race/ethnicity, smoking, body mass index, and C-reactive protein (CRP) levels in multivariate linear regression models (e.g., for HCV/HIV coinfected women, the adjusted association of sCD163 with FIB-4 was: b 5 0.58; 95% confidence interval: 0.38-0.78; P < 0.0001).Our data are consistent with those of Kazanko et al., but extend their findings in important ways. First, we observe that associations of sCD163 with measures of liver fibrosis are similar in both HCV monoinfected and HCV/HIV coinfected women. Second, the null associations of Gal-3BP and sCD14 with APRI/ FIB-4 suggest that sCD163 may be unique among plasma markers of macrophage abundance, polarization, and activation (Gal-3BP, sCD163, and sCD14) in its association with liver fibrosis. However, we note that both our study and that of Kazanko et al. are cross-sectional. Prospective studies are therefore needed to better understand the influence of macrophage activation and polarization on hepatic diseases.

show abstract

Section: Replymentioning

confidence: 95%

Reply

Kazankov¹,

Møller²,

Bibby³

et al. 2015

Hepatology

View full text Add to dashboard Cite

show abstract

“…The values were incorporated at AST-to- platelet ratio index (APRI), which was calculated to estimate the stage of fibrosis [ 20 ]. APRI have aside from HCV also been repeatedly validated in HCV/HIV co-infection [ 21 – 23 ] and HIV- mono-infected [ 24 ]. APRI score < 0.5 indicated lack of significant fibrosis as suggested by Resino et al [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

Low Levels of Microbial Translocation Marker LBP Are Associated with Sustained Viral Response after Anti-HCV Treatment in HIV-1/HCV Co-Infected Patients

et al. 2015

View full text Add to dashboard Cite

BackgroundMicrobial translocation (MT) contributes to immune activation during HIV and HCV infections. We investigated the kinetics of MT markers during anti-HCV and anti-HIV treatments, and if baseline plasma levels of lipopolysaccharide (LPS), lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14) could predict anti-HCV treatment outcome.MethodsPlasma from 78 HIV-infected patients was evaluated for LPS, LBP and sCD14. The patients starting anti-HCV treatment (with ongoing antiretroviral (ART) treatment) were categorized into sustained viral responders (SVR; n = 21) or non-responders (NR; n = 15) based on treatment outcome. ART starting subjects—were categorized into chronically HCV-infected (CH; n = 24) and mono-infected (HIV; n = 18), based on the HCV infection status. Samples were collected before start (at baseline) of pegylated-interferon-alpha/ribavirin (peg-IFN/RBV) or antiretroviral-therapy and two years after treatment start (at follow up). χ2–test, non-parametric statistics and logistic regression were applied to determine the associations with treatment response and changes of the soluble markers.ResultsPlasma levels of LPS and sCD14 were elevated in all subjects before antiviral-treatment but remained unchanged at follow-up. Elevated levels of LBP were present in patients with HIV and HIV/HCV co-infection and were reduced by ART. Additionally, higher levels of LBP were present at baseline in NR vs. SVR. Higher levels of LBP at baseline were associated with non-response to peg-IFN/RBV treatment in both bivariate (OR: 0.19 95% CI: 0.06–0.31, p = 0.004) and multivariate analysis (OR: 1.43, 95% CI: 1.1–1.86, p = 0.07).ConclusionIn HIV/HCV co-infected patients high baseline LBP levels are associated with non-response to peg-IFN/RBV therapy. Plasma LBP (decreased by ART) may be a more relevant MT marker than LPS and sCD14.

show abstract

“…Our results are sufficiently precise, with confidence intervals centered around the null, to provide evidence that that modest alcohol use did not significantly increase rates of fibrosis progression with adequate observation time to reasonably adjust for confounding in our statistical analyses. Finally, FIB-4 is a noninvasive modality for estimating liver fibrosis, but is less accurate than liver biopsy or transient elastography [34][35][36][37]. However, it has been validated in patients with HIV/HCV coinfection, as well as specifically in this cohort [19,20] CONCLUSIONS Alcohol use is common in HIV/HCV-coinfected women.…”

Section: Discussionmentioning

confidence: 99%