Serum biochemical markers accurately predict liver fibrosis in HIV and hepatitis C virus co-infected patients.
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.
Myers
Robert P
RP
Department of Hepatology and Gastroenterology, Hôpital La Pitié-Salpêtrière, Paris, France.
Benhamou
Yves
Y
Imbert-Bismut
Françoise
F
Thibault
Vincent
V
Bochet
Marie
M
Charlotte
Frédéric
F
Ratziu
Vlad
V
Bricaire
François
F
Katlama
Christine
C
Poynard
Thierry
T
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
D016632:Apolipoprotein A-I; D015415:Biomarkers; D000511:alpha-Macroglobulins; D005723:gamma-Glutamyltransferase