title: Non-invasive fibrosis biomarkers - APRI and Forns - are associated with liver stiffness in HIV-monoinfected patients receiving antiretroviral drugs.
abstract: OBJECTIVE
  HIV-monoinfected patients are susceptible to liver injury by different factors and may develop liver fibrosis, which requires adequate clinical management in terms of therapy and disease monitoring. We aimed to evaluate the presence of liver fibrosis identified by transient elastography (TE), its relationships with indirect biochemical markers [the aspartate aminotransferase/platelet ratio index (APRI), the Forns index and FIB-4] and its predictive factors in HIV-monoinfected patients receiving antiretroviral therapy (ART).
  
  
  METHODS
  Seventy-two HIV-monoinfected patients underwent TE and were evaluated using APRI, Forns and FIB-4. The clinical, immunological, virological and other biochemical characteristics were evaluated at the time of TE, together with their history of ART.
  
  
  RESULTS
  Seven patients (10%) had liver stiffness (LS) values predicting cirrhosis, and 12 (17%) had values predicting significant or advanced fibrosis. Higher indirect biochemical scores of liver fibrosis were significantly associated with higher LS values [APRI rs  = 0.4296 (P < 0.001); Forns rs  = 0.4754 (P < 0.001); FIB-4 rs  = 0.285 (P = 0.015)]. At multivariable analysis, APRI (β = 2.7405; P = 0.036), Forns (β = 1.4174; P = 0.029) and triglyceride levels (β = 1.3028; P = 0.007) were independently associated with LS.
  
  
  CONCLUSIONS
  Indirect fibrosis biomarkers may increase the probability to detect liver injury enhancing a specific diagnostic workup and so contribute to improving the clinical management of HIV-monoinfected patients with clinically suspected liver disease.
authors.affiliation: Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hasson
authors.forename: Marco
authors.initials: M
authors.lastname: Merli
authors.forename: Laura
authors.initials: L
authors.lastname: Galli
authors.forename: Giulia
authors.initials: G
authors.lastname: Gallotta
authors.forename: Alessia
authors.initials: A
authors.lastname: Carbone
authors.forename: Emanuela
authors.initials: E
authors.lastname: Messina
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bagaglio
authors.forename: Giulia
authors.initials: G
authors.lastname: Morsica
authors.forename: Stefania
authors.initials: S
authors.lastname: Salpietro
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
authors.forename: Caterina
authors.initials: C
authors.lastname: Uberti-Foppa
mesh_terms: D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000378:metabolism*; D001792:Blood Platelets / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D054459:Elasticity Imaging Techniques / Q000379:methods*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D002784:Cholesterol; D001219:Aspartate Aminotransferases
keywords: APRI; Forns index; HIV; antiretroviral therapy; transient elastography