Theodoros Androutsakos*, Maria Schina, Abraham Pouliakis, Athanasios Kontos, Nikolaos Sipsas and Gregorios Hatzis Pages 173 - 182 ( 10 )
Background: Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives.
Objectives: Our study’s aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients.
Methods: Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient.
Results: A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved.
Conclusion: Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.
HIV infection, transient elastography, liver fibrosis, non-invasive biomarkers, HBV, HCV.
Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Liver unit, Euroclinic of Athens, Athens, Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Infectious Diseases Unit, Laiko General Hospital, Athens, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens