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Meta-Analysis
. 2016 Oct;31(10):1684-1693.
doi: 10.1111/jgh.13337.

Use of transient elastography in patients with HIV-HCV coinfection: A systematic review and meta-analysis

Basile Njei  1   2 , Thomas R McCarty  3 , Jeffrey Luk  3 , Oforbuike Ewelukwa  4 , Ivo Ditah  5 , Joseph K Lim  6
Affiliations
Meta-Analysis

Use of transient elastography in patients with HIV-HCV coinfection: A systematic review and meta-analysis

Basile Njei et al. J Gastroenterol Hepatol. 2016 Oct.

Abstract

Background and aim: Patients with HIV-hepatitis C virus (HCV) coinfection progress towards liver fibrosis and cirrhosis more rapidly compared with HCV mono-infected individuals. This necessitates an accurate assessment of liver stiffness with transient elastography to guide treatment.

Methods: Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were performed through January 2016 to assess the diagnostic accuracy of transient elastography for liver stiffness in the HIV-HCV population. Included studies were analyzed according to the Cochrane DTA Working Group methodology. Bivariate and hierarchical models were used to compute pooled sensitivity and specificity. Positive and negative likelihood ratios were also determined. A Fagan nomogram was constructed. Meta-regression analysis was performed with assessment of publication bias using Deeks' funnel plot asymmetry testing.

Results: A total of six studies (n = 756) met the inclusion criteria. The diagnostic accuracy of elastography for the diagnosis of moderate (≥F2) fibrosis was 88% (95% confidence interval [CI], 0.85-0.90). The pooled sensitivity and specificity of moderate fibrosis was 97% (95% CI, 0.82-0.91) and 64% (95% CI, 0.45-0.79), respectively. The diagnostic accuracy of elastography for the assessment of cirrhosis was 94% (95% CI, 0.91-0.95). The pooled sensitivity and specificity for cirrhosis was 90% (95% CI, 0.74-0.97) and 87% (95% CI, 0.80-0.92), respectively. Meta-regression analysis demonstrated that CD4 cell count did not impact diagnostic accuracy of elastography.

Conclusions: Transient elastography is a noninvasive imaging modality with excellent ability to assess for cirrhosis in patients with HIV-HCV coinfection.

Keywords: HCV; HIV; elastography; fibrosis; hepatitis.

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Conflict of interest statement

Potential Conflicts of Interest: The authors have no potential conflicts of interest to report.

Figures

Figure 1
Figure 1. PRISMA Flow Chart of Search Results for Transient Elastography
Figure 2
Figure 2. QUADAS-2 Quality Assessment of Included Studies
Figure 3
Figure 3. A Forest Plot of All Included Studies for Transient Elastography
Figure 4
Figure 4. Diagnostic Accuracy of Transient Elastography for Moderate Fibrosis
Figure 5
Figure 5. Fagan nomogram for Transient Elastography for Moderate Fibrosis
Figure 6
Figure 6. Diagnostic Accuracy of Transient Elastography for Cirrhosis
Figure 7
Figure 7. Fagan nomogram for Transient Elastography for Cirrhosis
Figure 8
Figure 8. Meta-regression Analysis for Transient Elastography
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