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Comparative Study
. 2015 Sep 29;10(9):e0138838.
doi: 10.1371/journal.pone.0138838. eCollection 2015.

Progression of Liver Fibrosis in HIV/HCV Co-Infection: A Comparison between Non-Invasive Assessment Methods and Liver Biopsy

Patrick Schmid  1 , Andrea Bregenzer  1 , Milo Huber  2 , Andri Rauch  3 , Wolfram Jochum  4 , Beat Müllhaupt  5 , Pietro Vernazza  1 , Milos Opravil  2 , Rainer Weber  2 ; Swiss HIV Cohort Study
Collaborators, Affiliations
Comparative Study

Progression of Liver Fibrosis in HIV/HCV Co-Infection: A Comparison between Non-Invasive Assessment Methods and Liver Biopsy

Patrick Schmid et al. PLoS One. .

Abstract

Objectives: To evaluate the diagnostic performance of seven non-invasive tests (NITs) of liver fibrosis and to assess fibrosis progression over time in HIV/HCV co-infected patients.

Methods: Transient elastography (TE) and six blood tests were compared to histopathological fibrosis stage (METAVIR). Participants were followed over three years with NITs at yearly intervals.

Results: Area under the receiver operating characteristic curve (AUROC) for significant fibrosis (> = F2) in 105 participants was highest for TE (0.85), followed by FIB-4 (0.77), ELF-Test (0.77), APRI (0.76), Fibrotest (0.75), hyaluronic acid (0.70), and Hepascore (0.68). AUROC for cirrhosis (F4) was 0.97 for TE followed by FIB-4 (0.91), APRI (0.89), Fibrotest (0.84), Hepascore (0.82), ELF-Test (0.82), and hyaluronic acid (0.79). A three year follow-up was completed by 87 participants, all on antiretroviral therapy and in 20 patients who completed HCV treatment (9 with sustained virologic response). TE, APRI and Fibrotest did not significantly change during follow-up. There was weak evidence for an increase of FIB-4 (mean increase: 0.22, p = 0.07). 42 participants had a second liver biopsy: Among 38 participants with F0-F3 at baseline, 10 were progessors (1-stage increase in fibrosis, 8 participants; 2-stage, 1; 3-stage, 1). Among progressors, mean increase in TE was 3.35 kPa, in APRI 0.36, and in FIB-4 0.75. Fibrotest results did not change over 3 years.

Conclusion: TE was the best NIT for liver fibrosis staging in HIV/HCV co-infected patients. APRI-Score, FIB-4 Index, Fibrotest, and ELF-Test were less reliable. Routinely available APRI and FIB-4 performed as good as more expensive tests. NITs did not change significantly during a follow-up of three years, suggesting slow liver disease progression in a majority of HIV/HCV co-infected persons on antiretroviral therapy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. ROCs of transient elastography, APRI, FIB-4, Fibrotest for significant fibrosis (F> = 2).
ROC: receiver operating characteristic curve; fibro: transient elastography (TE); fibtest: Fibrotest®.
Fig 2
Fig 2. ROCs of transient elastography, hyaluronic acid, Hepascore, ELF-Test for significant fibrosis (F> = 2).
ROC: receiver operating characteristic curve; fibro: transient elastography (TE); hyaluron: hyaluronic acid; hepasco: Hepascore, ELF: Enhanced Liver Fibrosis-Test®.
Fig 3
Fig 3. ROCs of transient elastography, APRI, FIB-4, Fibrotest for cirrhosis (F4).
ROC: receiver operating characteristic curve; fibro: transient elastography (TE); fibtest: Fibrotest®.
Fig 4
Fig 4. ROCs of transient elastography, hyaluronic acid, Hepascore, ELF-Test for cirrhosis (F4).
ROC: receiver operating characteristic curve; fibro: transient elastography (TE); hyaluron: hyaluronic acid; hepasco: Hepascore, ELF: Enhanced Liver Fibrosis-Test®.
Fig 5
Fig 5. Change in transient elastography values (kPa) over time (3 years).
See this image and copyright information in PMC

References

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