FIB-4 index is associated with hepatocellular carcinoma risk in HIV-infected patients.
BACKGROUND
Chronic inflammation caused by hepatitis B virus infection, hepatitis C virus infection, and/or heavy alcohol use can lead to fibrosis, cirrhosis, and eventually hepatocellular carcinoma (HCC). FIB-4 is an index score calculated from platelet count, alanine transaminase, aspartate transaminase, and age that predicts fibrosis and cirrhosis. We hypothesized that high FIB-4 would be associated with development of HCC in HIV-infected persons, who are at high risk due to high prevalence of viral hepatitis and alcohol consumption, and possibly due to HIV infection itself.


METHODS
Using proportional hazards models, we tested this hypothesis among 22,980 HIV-infected men from the Veterans Aging Cohort Study. We identified incident HCC cases from the Veterans Affairs Central Cancer Registry.


RESULTS
During follow-up, there were 112 incident HCC diagnoses. The age- and race/ethnic group-adjusted HR was 4.2 [95% confidence interval (CI), 2.4-7.4] for intermediate FIB-4 and 13.0 (95% CI, 7.2-23.4) for high FIB-4, compared with low FIB-4. After further adjustment for enrollment year, CD4 count, HIV-1 RNA level, antiretroviral therapy use, hepatitis B and C virus infection, alcohol abuse/dependency, and diabetes, FIB-4 remained a strong, significant, independent risk factor for HCC. The multivariate-adjusted HR was 3.6 (95% CI, 2.1-6.4) for intermediate FIB-4 and 9.6 (95% CI, 5.2-17.4) for high FIB-4.


CONCLUSIONS
Calculated from routine, noninvasive laboratory tests, FIB-4 is a strong, independent HCC risk factor in HIV-infected patients.


CONCLUSIONS
FIB-4 might prove valuable as an easily measured index to identify those at highest risk for HCC, even prior to development of clinical cirrhosis.
Yale School of Medicine, West Haven, CT 06516, USA. lesley.park@yale.edu
Lesley S
LS
Park
Janet P
JP
Tate
Amy C
AC
Justice
Vincent
V
Lo Re
Joseph K
JK
Lim
Norbert
N
Bräu
Sheldon T
ST
Brown
Adeel A
AA
Butt
Cynthia
C
Gibert
Matthew Bidwell
MB
Goetz
David
D
Rimland
Maria C
MC
Rodriguez-Barradas
Robert
R
Dubrow
D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000032:analysis; D001219:Aspartate Aminotransferases / Q000032:analysis; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012307:Risk Factors
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase