Diagnosis of advanced fibrosis in HIV and hepatitis C virus-coinfected patients via a new noninvasive index: the HGM-3 index.
BACKGROUND
Noninvasive tests are increasingly being used for the assessment of liver fibrosis. We aimed to develop a serum index for the identification of advanced fibrosis (F>or=3) in HIV/hepatitis C virus (HCV)-coinfected patients.


METHODS
We carried out a cross-sectional study on a group of 195 patients comprised of an estimation group (EG; n=127) and a validation group (VG; n=68) who all underwent liver biopsy and had not received previous interferon therapy. Liver fibrosis was estimated using the METAVIR score. We developed a new serum index (HGM-3) dependent on levels of platelets, alkaline phosphatase, hepatic growth factor, tissue inhibitor of metalloproteinase-1 and hyaluronic acid.


RESULTS
In the EG, the area under the receiver operating characteristic curve (AUC-ROC) of HGM-3 for identification of F>or=3 was 0.939 [95% confidence interval (CI) 0.899, 0.979] which was significantly higher than the AUC-ROC of the HGM-2, FIB-4, aspartate aminotransferase to platelet ratio (APRI) and Forns' indexes. With HGM-3 <0.135 for F<3, 57 patients were correctly identified and two patients were misclassified. We found the presence of F<3 with 96.6% certainty. The negative likelihood ratio (LR) was <0.1 and the diagnostic odds ratio (DOR) was >40. With HGM-3 >0.570 in the EG for F>or=3, 31 patients were correctly identified, and five patients were misclassified. We found the presence of F>or=3 with 86.1% certainty. The positive LR was >12 and the DOR was >40. For the VG, the diagnostic accuracy values were similar to the values for the EG.


CONCLUSIONS
HGM-3 appears to be an accurate noninvasive method for the diagnosis of bridging fibrosis and cirrhosis in HIV/HCV-coinfected patients.
Resino
S
S
Laboratory of Molecular Epidemiology of Infectious Diseases, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. sresino@isciii.es
Micheloud
D
D
Miralles
P
P
Bellón
J M
JM
Vargas
A
A
Catalán
P
P
Alvarez
E
E
Cosín
J
J
Lorente
R
R
López
J C
JC
Muñoz-Fernández
M A
MA
Berenguer
J
J
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications*; D017228:Hepatocyte Growth Factor / Q000097:blood; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis*; D008297:Male; D010976:Platelet Count; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood
D015415:Biomarkers; D019715:Tissue Inhibitor of Metalloproteinase-1; D017228:Hepatocyte Growth Factor; D006820:Hyaluronic Acid; D000469:Alkaline Phosphatase