Prediction of hepatic fibrosis in HIV/HCV co-infected patients using serum fibrosis markers: the SHASTA index.
OBJECTIVE
To examine if serum fibrosis biomarkers could accurately identify the stage of liver disease amongst hepatitis C (HCV) and HIV co-infected patients.


METHODS
One hundred and thirty seven HIV/HCV co-infected persons were randomly selected from the Johns Hopkins HIV Clinic cohort. Ninety five had complete testing for fibrosis markers in sera collected at the time of liver biopsy. Biopsies were scored according to Ishak modified histological activity index (F0 no fibrosis to F6 cirrhosis). Fibrosis was evaluated against alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST to platelet ratio (APRI), albumin, total bilirubin, hyaluronic acid (HA) and YKL-40.


RESULTS
Sixty nine (73%) had no or minimal portal fibrosis (F0-2) and were compared with remaining subjects (F3-6). Fibrosis scores > or =F3 were found 27 times more often in persons with HA levels >86 ng/ml and 5.5 times more often in persons with HA levels 41-86 ng/ml. Less substantial associations were detected with levels of albumin <3.5 g/dl (OR 4.85) and AST >60 iu (OR 5.91). All 35 subjects who had favorable results of HA, albumin, and AST had minimal fibrosis (F0-2).


CONCLUSIONS
Amongst HIV/HCV co-infected patients, serum testing for HA, albumin, and AST (SHASTA Index) was able to accurately stage mild and advanced fibrosis.
Kelleher
Thomas B
TB
Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 8E, Boston, MA 02215, USA.
Mehta
Shruti H
SH
Bhaskar
Ramakrishnan
R
Sulkowski
Mark
M
Astemborski
Jacquie
J
Thomas
David L
DL
Moore
Richard E
RE
Afdhal
Nezam H
NH
D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index
D015415:Biomarkers; D012709:Serum Albumin; D006820:Hyaluronic Acid; D001219:Aspartate Aminotransferases