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LIVER FIBROSIS |
1 Hospital Universitario de Valme, Seville, Spain
2 Hospital Universitario Puerta del Mar, Cadiz, Spain
3 Hospital Universitario Virgen de la Victoria, Malaga, Spain
4 Hospital Juan Ramón Jiménez, Huelva, Spain
5 Hospital Universitario Reina Sofía, Cordoba, Spain
Correspondence to:
Correspondence to:
Dr J A Pineda
Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Ctra de Cádiz s/n, 41014 Seville, Spain; japineda{at}nacom.es
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.
Keywords: human immunodeficiency virus; hepatitis C virus; coinfection; liver biopsy; liver fibrosis; predictive models
Relevant Article
Gut 2006 55: 310-312.
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  J. Macias, F. Orihuela, A. Rivero, P. Viciana, M. Marquez, J. Portilla, M. J. Rios, L. Munoz, J. Pasquau, M. A. Castano, et al. Hepatic safety of tipranavir plus ritonavir (TPV/r)-based antiretroviral combinations: effect of hepatitis virus co-infection and pre-existing fibrosis J. Antimicrob. Chemother., October 24, 2008; (2008) dkn429v1. [Abstract] [Full Text] [PDF]
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S. Vergara, J. Macias, J. A. Mira, J. A. Garcia-Garcia, N. Merchante, J. del Valle, L. Abdel-Kader, F. Lozano, J. M. Gomez-Mateos, and J. A. Pineda Low-level liver enzyme elevations during HAART are not associated with liver fibrosis progression among HIV/HCV-coinfected patients J. Antimicrob. Chemother., January 1, 2007; 59(1): 87 - 91. [Abstract] [Full Text] [PDF]
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 M Pinzani Non-invasive evaluation of hepatic fibrosis: don't count your chickens before they're hatched Gut, March 1, 2006; 55(3): 310 - 312. [Full Text] [PDF]
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