Impact of liver steatosis on the correlation between liver stiffness and fibrosis measured by transient elastography in patients coinfected with human immunodeficiency virus and hepatitis C virus.
We assessed the effect of different hepatic conditions such as fibrosis, steatosis and necroinflammatory activity on liver stiffness as measured by transient elastography in HIV/HCV-coinfected patients. We studied all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and elastography between January 2007 and December 2008. Liver fibrosis was staged following METAVIR Cooperative Study Group criteria. Steatosis was categorized according to the percentage of affected hepatocytes as low (≤10%), moderate (<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29; F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic steatosis in 68 patients (low to moderate, n = 53; and severe n = 15). By univariate regression analysis, fibrosis, necroinflammatory activity, and the degree of steatosis were correlated with liver stiffness. However, in a multiple regression analysis, steatosis and fibrosis were the only independent variables significantly associated with liver stiffness. With a cut-off of 9.5 kPa to distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a significantly higher number of misclassification errors (25%vs 5%; P = 0.014), most of which were false positives for F ≥ 3. Our study suggests that the correlation between liver stiffness and fibrosis as estimated by transient elastography may be affected by the presence of hepatic steatosis in HIV/HCV-coinfected patients.
Infectious Diseases and HIV Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain. msconde@gmail.com
M
M
Sánchez-Conde
M L
ML
Montes Ramírez
J M
JM
Bellón Cano
A
A
Caminoa
F
F
Alvarez Rodríguez
J
J
González Garcia
P
P
Miralles Martín
I
I
Bernardino de la Serna
J C López
JC
Bernardo de Quirós
J R
JR
Arribas López
J
J
Cosín Ochaíta
J F
JF
Pascual Pareja
E
E
Alvarez
J B
JB
Berenguer
D000328:Adult; D060085:Coinfection; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000150:complications / Q000473:pathology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged