Noninvasive diagnosis of liver fibrosis in patients with HIV infection and HCV/HBV co‐infection

Moreno, Santiago; García‐Samaniego, J.; Moreno, Ana; Ortega, Enrique; Pineda, Juan A.; Romero, Jorge del; Tural, Cristina; Wichmann, Miguel Ángel von; Berenguer, Juan; Castro, Ángeles; Espacio, R.

doi:10.1111/j.1365-2893.2009.01088.x

Cited by 27 publications

(22 citation statements)

References 53 publications

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“…Aside from these laboratory biomarkers, liver fibrosis is evaluated using transient elastography (FibroScan) [42]. Our group reported an excellent diagnostic performance of liver stiffness for fibrosis and cirrhosis in HIV/HCV-coinfected patients [43], which was higher than the diagnostic performance of HA shown here.…”

Section: Discussionmentioning

confidence: 92%

Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

et al. 2010

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BackgroundHyaluronic acid (HA) serum levels correlate with the histological stages of liver fibrosis in hepatitis C virus (HCV) monoinfected patients, and HA alone has shown very good diagnostic accuracy as a non-invasive assessment of fibrosis and cirrhosis. The aim of this study was to evaluate serum HA levels as a simple non-invasive diagnostic test to predict hepatic fibrosis in HIV/HCV-coinfected patients and to compare its diagnostic performance with other previously published simple non-invasive indexes consisting of routine parameters (HGM-1, HGM-2, Forns, APRI, and FIB-4).MethodsWe carried out a cross-sectional study on 201 patients who all underwent liver biopsies and had not previously received interferon therapy. Liver fibrosis was determined via METAVIR score. The diagnostic accuracy of HA was assessed by area under the receiver operating characteristic curves (AUROCs).ResultsThe distribution of liver fibrosis in our cohort was 58.2% with significant fibrosis (F≥2), 31.8% with advanced fibrosis (F≥3), and 11.4% with cirrhosis (F4). Values for the AUROC of HA levels corresponding to significant fibrosis (F≥2), advanced fibrosis (F≥3) and cirrhosis (F4) were 0.676, 0.772, and 0.863, respectively. The AUROC values for HA were similar to those for HGM-1, HGM-2, FIB-4, APRI, and Forns indexes. The best diagnostic accuracy of HA was found for the diagnosis of cirrhosis (F4): the value of HA at the low cut-off (1182 ng/mL) excluded cirrhosis (F4) with a negative predictive value of 99% and at the high cut-off (2400 ng/mL) confirmed cirrhosis (F4) with a positive predictive value of 55%. By utilizing these low and high cut-off points for cirrhosis, biopsies could have theoretically been avoided in 52.2% (111/201) of the patients.ConclusionsThe diagnostic accuracy of serum HA levels increases gradually with the hepatic fibrosis stage. However, HA is better than other simple non-invasive indexes using parameters easily available in routine clinical practice only for the diagnosing of cirrhosis.

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Section: Discussionmentioning

confidence: 92%

Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

et al. 2010

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“…Treatment efficacy should also be evaluated on the basis of liver fibrosis regression under treatment. Two studies based on repeated liver biopsies have reported regression of extensive fibrosis and even cirrhosis under TDF,75 76 also seen by means of non-invasive markers 75 83 84…”

Section: Hepatitis B: Remaining Challenges In Diagnosis Treatment Anmentioning

confidence: 97%

HIV and viral hepatitis coinfections: advances and challenges

Lacombe

Rockstroh

2012

Gut

143

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With a prevalence affecting over 30% of HIV infected patients, coinfection with hepatitis B (HBV) or C (HCV) virus remains one of the most frequent comorbidities in this population, with a significant impact in terms of morbidity and mortality associated with liver disease. Recent findings in the physiopathology of HIV in the liver have confirmed that it may contribute, along with hepatotoxicity of antiretrovirals and the burden of metabolic diseases, to a more rapid progression of liver fibrosis, especially when there is underlying chronic hepatitis coinfection. Both fields of research and clinical appraisal of HBV and HCV coinfection are rapidly evolving and prompt a change in the former paradigms of clinical care and management of chronic hepatic coinfection in the context of HIV. The advent of anti-HCV direct antiviral agents has indeed completely shaken up the treatment guidelines for HCV, and the tricky management of these new agents with antiretrovirals means referring patients to specialised centres. In HBV coinfection, therapeutic options have not changed recently but new challenges have emerged regarding the management of low replicating HBV-DNA in optimally treated patients and long term exposure to antivirals. Finally, the global increase in life expectancy in HIV infected patients has been accompanied in coinfected patients by a higher risk of emergence of end stage liver diseases for which access to orthotopic liver transplantation and innovative procedures such as targeted hepatocellular carcinoma therapies should be facilitated.

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“…The median number of portal tracts was 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The median number of portal tracts was 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Liver Biopsymentioning

confidence: 99%

Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: A multicenter prospective study (the FIBROSTIC study)

Degos

Perez

Roche

et al. 2010

Journal of Hepatology

393

262

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Noninvasive diagnosis of liver fibrosis in patients with HIV infection and HCV/HBV co‐infection

Cited by 27 publications

References 53 publications

Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

HIV and viral hepatitis coinfections: advances and challenges

Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: A multicenter prospective study (the FIBROSTIC study)

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