Comparison of liver fibrosis blood tests developed for HCV with new specific tests in HIV/HCV co-infection.
OBJECTIVE
We compared 5 non-specific and 2 specific blood tests for liver fibrosis in HCV/HIV co-infection.


METHODS
Four hundred and sixty-seven patients were included into derivation (n=183) or validation (n=284) populations. Within these populations, the diagnostic target, significant fibrosis (Metavir F > or = 2), was found in 66% and 72% of the patients, respectively. Two new fibrosis tests, FibroMeter HICV and HICV test, were constructed in the derivation population.


RESULTS
Unadjusted AUROCs in the derivation population were: APRI: 0.716, Fib-4: 0.722, Fibrotest: 0.778, Hepascore: 0.779, FibroMeter: 0.783, HICV test: 0.822, FibroMeter HICV: 0.828. AUROCs adjusted on classification and distribution of fibrosis stages in a reference population showed similar values in both populations. FibroMeter, FibroMeter HICV and HICV test had the highest correct classification rates in F0/1 and F3/4 (which account for high predictive values): 77-79% vs. 70-72% in the other tests (p=0.002). Reliable individual diagnosis based on predictive values > or = 90% distinguished three test categories: poorly reliable: Fib-4 (2.4% of patients), APRI (8.9%); moderately reliable: Fibrotest (25.4%), FibroMeter (26.6%), Hepascore (30.2%); acceptably reliable: HICV test (40.2%), FibroMeter HICV (45.6%) (p<10(-3) between tests). FibroMeter HICV classified all patients into four reliable diagnosis intervals (< or =F1, F1+/-1, > or =F1, > or =F2) with an overall accuracy of 93% vs. 79% (p<10(-3)) for a binary diagnosis of significant fibrosis.


CONCLUSIONS
Tests designed for HCV infections are less effective in HIV/HCV infections. A specific test, like FibroMeter HICV, was the most interesting test for diagnostic accuracy, correct classification profile, and a reliable diagnosis. With reliable diagnosis intervals, liver biopsy can therefore be avoided in all patients.
Calès
Paul
P
Hepatology Department, University Hospital, Angers, France. paul.cales@univ-angers.fr
Halfon
Philippe
P
Batisse
Dominique
D
Carrat
Fabrice
F
Perré
Philippe
P
Penaranda
Guillaume
G
Guyader
Dominique
D
d'Alteroche
Louis
L
Fouchard-Hubert
Isabelle
I
Michelet
Christian
C
Veillon
Pascal
P
Lambert
Jérôme
J
Weiss
Laurence
L
Salmon
Dominique
D
Cacoub
Patrice
P
D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications*; D006403:Hematologic Tests / Q000379:methods*; D006526:Hepatitis C / Q000097:blood* / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011516:Prothrombin / Q000378:metabolism; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000511:alpha-Macroglobulins / Q000378:metabolism
D015415:Biomarkers; D000511:alpha-Macroglobulins; D011516:Prothrombin; D001219:Aspartate Aminotransferases