title: Systematic review and meta-analysis of the diagnostic accuracy of fibrosis marker panels in patients with HIV/hepatitis C coinfection.
abstract: BACKGROUND
  Accurately staging hepatitis C virus (HCV)-related fibrosis is crucial for treatment decisions and prognostication. Our objective was to systematically review studies describing the accuracy of serum marker panels for predicting fibrosis in HIV/HCV-coinfected patients.
  
  
  METHODS
  Studies comparing serum marker panels with biopsy in HIV/HCV-coinfected patients were identified. Random effects meta-analyses and areas under summary receiver operating characteristics curves (AUC) examined test accuracy for detecting significant fibrosis (F2-4) and cirrhosis. Heterogeneity was explored using meta-regression.
  
  
  RESULTS
  Five studies (n = 574) including four fibrosis measures (APRI [n = 4 studies], Forns' [n = 2], FibroTest [n = 1], SHASTA [n = 1]) met the inclusion criteria. The prevalence of significant fibrosis and cirrhosis were 51% and 16%, respectively. For the prediction of significant fibrosis, the summary AUC was 0.82 (95% CI 0.78-86) and diagnostic odds ratio was 7.8 (5.1-11.9). For cirrhosis, these figures were 0.83 (0.69-0.97) and 11.0 (4.6-26.2), respectively. Meta-regression including study factors (methodological quality and biopsy adequacy), patient characteristics (age, gender, CD4 count), and fibrosis measure failed to identify important predictors of accuracy.
  
  
  CONCLUSIONS
  Available fibrosis marker panels have acceptable performance for identifying significant fibrosis and cirrhosis in HIV/HCV-coinfected patients but are not yet adequate to replace liver biopsy. Additional studies are necessary to identify the optimal measure.
authors.affiliation: Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Abdel Aziz M
authors.initials: AA
authors.lastname: Shaheen
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers