title: Serum biochemical markers accurately predict liver fibrosis in HIV and hepatitis C virus co-infected patients.
abstract: OBJECTIVE
  Liver biopsy, the gold standard for assessing hepatitis C virus (HCV)-related fibrosis, is invasive and prone to complications. Our aim was to determine the operating characteristics of a non-invasive index of biochemical markers for the prediction of fibrosis in patients with HIV/HCV co-infection.
  
  
  METHODS
  In a cross-sectional, cohort study in a French tertiary-care hospital 130 HIV/HCV-co-infected patients with a liver biopsy and serum were tested for markers of liver fibrosis.
  
  
  METHODS
  An index incorporating age, sex, alpha(2)-macroglobulin, apolipoprotein A1, haptoglobin, bilirubin, and gamma-glutamyl-transpeptidase (GGT), derived using multivariate logistic regression, was compared with liver histology. HIV-specific indices including the CD4 cell count and HIV-RNA load were also constructed. The diagnostic values of the indices were compared using receiver operating characteristic (ROC) curves.
  
  
  METHODS
  Septal fibrosis (F2-F4) by the METAVIR classification.
  
  
  RESULTS
  By multivariate analysis, the most informative markers were alpha(2)-macroglobulin, apolipoprotein A1, GGT, and sex. The area under the ROC curve of the five-marker index was 0.856 +/- 0.035; not significantly different from the HIV-specific indices. On a scale from zero to 1.00, the five-marker index had a positive predictive value of 86% for scores greater than 0.60, and a negative predictive value of 93% for scores of 0.20 or less. These thresholds could reduce the necessity for liver biopsy by 55% while maintaining an accuracy of 89%.
  
  
  CONCLUSIONS
  An index including five biochemical markers accurately predicts significant fibrosis in patients with HIV/HCV co-infection, and may substantially reduce the necessity for liver biopsy.
authors.affiliation: Department of Hepatology and Gastroenterology, Hôpital La Pitié-Salpêtrière, Paris, France.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Yves
authors.initials: Y
authors.lastname: Benhamou
authors.forename: Françoise
authors.initials: F
authors.lastname: Imbert-Bismut
authors.forename: Vincent
authors.initials: V
authors.lastname: Thibault
authors.forename: Marie
authors.initials: M
authors.lastname: Bochet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Charlotte
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: François
authors.initials: F
authors.lastname: Bricaire
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
mesh_terms: D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D019562:Viral Load; D000511:alpha-Macroglobulins / Q000032:analysis; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D016632:Apolipoprotein A-I; D015415:Biomarkers; D000511:alpha-Macroglobulins; D005723:gamma-Glutamyltransferase