Impact of liver steatosis on the correlation between liver stiffness and fibrosis measured by transient elastography in patients coinfected with human immunodeficiency virus and hepatitis C virus

Abstract

We assessed the effect of different hepatic conditions such as fibrosis, steatosis and necroinflammatory activity on liver stiffness as measured by transient elastography in HIV/HCV-coinfected patients. We studied all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and elastography between January 2007 and December 2008. Liver fibrosis was staged following METAVIR Cooperative Study Group criteria. Steatosis was categorized according to the percentage of affected hepatocytes as low (≤10%), moderate (<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29; F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic steatosis in 68 patients (low to moderate, n = 53; and severe n = 15). By univariate regression analysis, fibrosis, necroinflammatory activity, and the degree of steatosis were correlated with liver stiffness. However, in a multiple regression analysis, steatosis and fibrosis were the only independent variables significantly associated with liver stiffness. With a cut-off of 9.5 kPa to distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a significantly higher number of misclassification errors (25%vs 5%; P = 0.014), most of which were false positives for F ≥ 3. Our study suggests that the correlation between liver stiffness and fibrosis as estimated by transient elastography may be affected by the presence of hepatic steatosis in HIV/HCV-coinfected patients.

Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis

“…More than 40% of individuals with transient elastography measure at least 20 kPa did not have esophageal varices and/or PHG. Transient elastography measures are increased by other comorbid situations such as inflammation, liver esteatosis, blood congestion, hepatocarcinoma and so on [26][27][28]. We think some of these comorbid situations, more frequent in HIVinfected individuals, are responsible for the low PPV of transient elastography in esophageal varices diagnosing.…”

Shear-Wave Elastography for the Estimation of Liver Fibrosis in Chronic Liver Disease: Determining Accuracy and Ideal Site for Measurement

“…Other studies have suggested that inflammation, as suggested by elevated transaminase levels (24,25) or diagnosed at liver biopsy (26)(27)(28), affects transient elastography assessment of fibrosis. Similarly, steatosis has been reported to have no effect on acoustic radiation force imaging-based fibrosis assessment (29), whereas in several transient elastography studies, steatosis has been reported to have an effect on noninvasive fibrosis staging (28,30,31). It is possible our finding of correlation between liver steatosis and SWE liver stiffness estimates in the left lobe represents a type I error.…”

Assessment of liver disease (noninvasive methods)

“…A second study by Sanchez-Conde et al focused on factors associated with misclassification by TE compared to biopsy in 110 patients [31]. Based on a cutoff of 9.5 kPa to distinguish patients with advanced fibrosis (≥F3) from those without advanced fibrosis, misclassification rates were higher among patients with steatosis compared to those without (25% vs. 5%, p=0.01).…”