Prediction of liver fibrosis in human immunodeficiency virus/hepatitis C virus coinfected patients by simple non-invasive indexes

Abstract

Background: Liver biopsy is an invasive technique with associated major complications. There is no information on the validity of five non-invasive indexes based on routinely available parameters, estimated and validated in hepatitis C virus (HCV) monoinfected patients, in human immunodeficiency virus (HIV)/ HCV coinfected patients. Aim: To validate these predictive models of liver fibrosis in HIV/HCV coinfected patients. Patients: A total of 357 (90%) of 398 patients from five hospitals were investigated, who underwent liver biopsy and who had complete data to validate all of the models considered. Methods: The predictive accuracy of the indexes was tested by measuring areas under the receiver operating characteristic curves. Diagnostic accuracy was calculated by estimating sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values. Results: The models performed better when liver biopsies >15 mm were used as reference. In this setting, the Forns and Wai indexes, models aimed at discriminating significant fibrosis, showed PPV of 94% and 87%, respectively. Using these models, 27-34% of patients could benefit from exclusion of liver biopsy. If both models were applied sequentially, 41% of liver biopsies could be spared. The indexes aimed at predicting cirrhosis achieved NPV of up to 100%. However, they showed very low PPV. Conclusions: The diagnostic accuracy of these models was lower in HIV/HCV coinfected patients than in the validation studies performed in HCV monoinfected patients. However, simple fibrosis tests may render liver biopsy unnecessary in deciding anti-HCV treatment in over one third of patients with HIV infection and chronic hepatitis C.

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

“…Nineteen studies included HCVmonoinfected patients (n ϭ 3,822), 17,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and 4 included HIV/HCV-co-infected patients (n ϭ 444). [48][49][50][51] Biopsy quality was considered acceptable in only 4 of the 22 studies. 51,53,57,63 According to the Quality Assessment of Diagnostic Accuracy Studies scale, the methodological quality of the included studies was very good.…”

“…[48][49][50][51] Biopsy quality was considered acceptable in only 4 of the 22 studies. 51,53,57,63 According to the Quality Assessment of Diagnostic Accuracy Studies scale, the methodological quality of the included studies was very good. Thirteen studies met all 14 requirements of this scale; 6 studies met 13, and 2 studies met 12.…”

A dose-up of ursodeoxycholic acid decreases transaminases in hepatitis C patients

“…In patients with hepatitis C virus-related chronic liver diseases, platelet counts reflect histological findings. When the platelet count is low in the patient, progression of liver fibrosis is suggested [30][31][32][33] . It is necessary to show histologically the morphological hepatic tissue changes in future studies.…”

Toxicité des antirétroviraux chez les patients co-infectés par les virus VIH et VHC

“…Celle-ci est maintenant évaluée par le biais de tests biologiques associant plusieurs paramètres biochimiques sanguins plutôt que la biopsie hépatique. Parmi ces tests, le fibrotest, de plus en plus reconnu et utilisé pour évaluer la fibrose chez les patients infectés par le VHC [13] a été validé chez les patients coinfectés [39]. Il existe d'autres associations de marqueurs séri-ques de la fibrose testés chez ces malades tels que l'index SHASTA [34].…”