title: Accuracy of simple biochemical tests in identifying liver fibrosis in patients co-infected with human immunodeficiency virus and hepatitis C virus.
abstract: OBJECTIVE
  We assessed the ability of 3 simple biochemical tests to stage liver fibrosis in patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV).
  
  
  METHODS
  We analyzed liver biopsy samples from 324 consecutive HIV/HCV-positive patients (72% men; mean age, 38 y; mean CD4+ T-cell counts, 548 cells/mm(3)). Scheuer fibrosis scores were as follows: 30% had F0, 22% had F1, 19% had F2, 23% had F3, and 6% had F4. Logistic regression analyses were used to predict the probability of significant (>or=F2) or advanced (>or=F3) fibrosis, based on numeric scores from the APRI, FORNS, or FIB-4 tests (alone and in combination). Area under the receiver operating characteristic curves were analyzed to assess diagnostic performance.
  
  
  RESULTS
  Area under the receiver operating characteristic curves analyses indicated that the 3 tests had similar abilities to identify F2 and F3; the ability of APRI, FORNS, and FIB-4 were as follows: F2 or greater: 0.72, 0.67, and 0.72, respectively; F3 or greater: 0.75, 0.73, and 0.78, respectively. The accuracy of each test in predicting which samples were F3 or greater was significantly higher than for F2 or greater (APRI, FORNS, and FIB-4: >or=F3: 75%, 76%, and 76%, respectively; >or=F2: 66%, 62%, and 68%, respectively). By using the lowest cut-off values for all 3 tests, F3 or greater was ruled out with sensitivity and negative predictive values of 79% to 94% and 87% to 91%, respectively, and 47% to 70% accuracy. Advanced liver fibrosis (>or=F3) was identified using the highest cut-off value, with specificity and positive predictive values of 90% to 96% and 63% to 73%, respectively, and 75% to 77% accuracy.
  
  
  CONCLUSIONS
  Simple biochemical tests accurately predicted liver fibrosis in more than half the HIV/HCV co-infected patients. The absence and presence of liver fibrosis are predicted fairly using the lowest and highest cut-off levels, respectively.
authors.affiliation: HIV Clinical Unit, Fundació de la Lluita contra la SIDA, Barcelona, Spain. ctural.germanstrias@gencat.cat
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.forename: Jordi
authors.initials: J
authors.lastname: Tor
authors.forename: Arantza
authors.initials: A
authors.lastname: Sanvisens
authors.forename: Núria
authors.initials: N
authors.lastname: Pérez-Alvarez
authors.forename: Elisenda
authors.initials: E
authors.lastname: Martínez
authors.forename: Isabel
authors.initials: I
authors.lastname: Ojanguren
authors.forename: Javier
authors.initials: J
authors.lastname: García-Samaniego
authors.forename: Juergen
authors.initials: J
authors.lastname: Rockstroh
authors.forename: Eva
authors.initials: E
authors.lastname: Barluenga
authors.forename: Robert
authors.initials: R
authors.lastname: Muga
authors.forename: Ramon
authors.initials: R
authors.lastname: Planas
authors.forename: Guillem
authors.initials: G
authors.lastname: Sirera
authors.forename: Celestino
authors.initials: C
authors.lastname: Rey-Joly
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006403:Hematologic Tests / Q000379:methods*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult