Noninvasive Models for Predicting Liver Fibrosis in Individuals with Hepatitis D Virus/Hepatitis B Virus Coinfection in the Brazilian Amazon Region

Abstract

Hepatitis D virus (HDV) genotype III is endemic in the western Amazon basin and is considered to cause the most severe form of chronic viral hepatitis. Recently, noninvasive fibrosis scores to determine the stage of liver fibrosis have been evaluated in individuals positive for HDV genotype I, but their utility in HDV genotype III-positive patients is unknown. In this retrospective study conducted in an outpatient viral hepatitis referral clinic in the Brazilian Amazon region, the aspartate aminotransferase (AST) to Aspartate aminotransferase to Platelet Ratio Index (APRI) and Fibrosis Index for Liver Fibrosis (FIB-4) values were calculated and compared with histological fibrosis stages. Among the 50 patients analyzed, the median age at liver biopsy was 35.6 years, 66% were male, and all had compensated liver disease. Histological staging revealed fibrosis stages 0, 1, 2, 3, and 4 in four (8%), eight (16%), 11 (22), 11 (22%), and 16 (32%) patients, respectively. The area under the receiver operating curve (AUROC) of AST-to-alanine aminotransferase (ALT) ratio, APRI, and FIB-4 for detection of significant fibrosis (F ≥ 2) was 0.550 (P = 0.601), 0.853 (P < 0.001), and 0.853 (P < 0.0001), respectively. Lower AUROC values were obtained for cirrhosis: the AST-to-ALT ratio was 0.640 (P = 0.114), APRI was 0.671 (P = 0.053), and FIB-4 was 0.701 (P = 0.023). The optimal cutoff value for significant fibrosis for APRI was 0.708 (sensitivity 84% and specificity 92%) and for FIB-4 was 1.36 (sensitivity 76% and specificity 92%). Aspartate aminotransferase to Platelet Ratio Index and FIB-4 were less useful to predict cirrhosis. In contrast to recent reports from Europe and North America, both APRI and FIB-4 may identify significant fibrosis in HDV-III-infected patients from northwestern Brazil.

Figure 1.

Receiver operating curves for aspartate aminotransferase (AST)/alanine aminotransferase (ALT), Aspartate aminotransferase to Platelet Ratio Index (APRI), and FIB-4 for detection of significant fibrosis (F2, F3, and F4). This figure appears in color at www.ajtmh.org.

Figure 2.

Receiver operating curves for aspartate aminotransferase (AST)/alanine aminotransferase (ALT), Aspartate aminotransferase to Platelet Ratio Index (APRI), and FIB-4 for detection of severe fibrosis (F3 and F4). This figure appears in color at www.ajtmh.org.

Figure 3.

Receiver operating curves for aspartate aminotransferase (AST)/alanine aminotransferase (ALT), Aspartate aminotransferase to Platelet Ratio Index (APRI), and FIB-4 for detection of cirrhosis (F4). This figure appears in color at www.ajtmh.org.