Noninvasive diagnosis of hepatic fibrosis in HIV/HCV-coinfected patients.
BACKGROUND
Several serum markers reflecting extracellular matrix status have been correlated with liver fibrosis in non-HIV-infected patients with chronic hepatitis C infection. These indexes have been less examined in HIV/HCV-coinfected individuals.


OBJECTIVE
We aimed to evaluate the predictive value of serum markers for liver fibrosis in HIV-infected patients with chronic hepatitis C virus (HVC).


METHODS
Serum levels of metalloproteinases 1 and 2 (MMP-1 and -2), tissue inhibitors of matrix metalloproteinases (TIMP-1), procollagen type III N-terminal peptide (PIIINP), and hyaluronic acid (HA) were measured in HIV-infected patients with chronic hepatitis C at the time of obtaining a liver biopsy and before the consideration of anti-hepatitis C therapy.


RESULTS
One hundred and nineteen consecutive HIV-HVC coinfected patients were included. TIMP-1 (r = 0.6; P < 0.001), TIMP-1/MMP-1 ratio (r = 0.5; P < 0.001), TIMP-1/MMP-2 ratio (r = 0.3; P < 0.001), MMP-2 (r = 0.2; P = 0.044), PIIINP (r = 0.4; P < 0.001), and HA (r = 0.5; P < 0.001) were positively and significantly correlated with the fibrosis stage. In the multivariate analysis, TIMP-1 (odds ratio [OR] = 1.004, 95% confidence interval [CI]: 1.002 to 1.006, P = 0.001) and HA >95 microg/dL (OR = 6.041, 95% CI: 1.184 to 30.816, P = 0.031) were independently associated with liver fibrosis. The area under the curve of score to discriminate mild (F0-F1) from significant (F2-F4) fibrosis in the received-operating analysis using the variables TIMP-1 and HA was 0.84, with a sensitivity of 72.9% and a specificity of 83.1%.


CONCLUSIONS
TIMP-1 and HA were quite sensitive and specific for predicting the degree of liver fibrosis in HIV-infected patients with chronic hepatitis C. These parameters may become a noninvasive alternative to liver biopsy when the degree of liver fibrosis needs to be estimated.
Larrousse
Maria
M
Infectious Diseases Unit, Hospital Clínic Universitari de Barcelona-IDIBAPS, University of Barcelona, Spain. mlarrou@clinic.ub.es
Laguno
Montserrat
M
Segarra
Marta
M
De Lazzari
Elisa
E
Martinez
Esteban
E
Blanco
José Luis
JL
León
Agathe
A
Deulofeu
Ramón
R
Miquel
Rosa
R
Milinkovic
Ana
A
Lonca
Montserrat
M
Miró
José María
JM
Biglia
Alejandra
A
Murillas
Javier
J
Gatell
José María
JM
Mallolas
Josep
J
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000473:pathology*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000821:virology*; D008297:Male; D020782:Matrix Metalloproteinases / Q000097:blood; D012367:RNA, Viral / Q000097:blood; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood; D019562:Viral Load
D015415:Biomarkers; D012367:RNA, Viral; D019715:Tissue Inhibitor of Metalloproteinase-1; D020782:Matrix Metalloproteinases