title: Comparison of the prognostic value of liver biopsy and FIB-4 index in patients coinfected with HIV and hepatitis C virus.
abstract: BACKGROUND
  We compared the prognostic value of liver biopsy (LB) and FIB-4 index in patients with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection.
  
  
  METHODS
  We studied patients from the Grupo de Estudio del SIDA 3603 study cohort, in whom fibrosis was evaluated at baseline using both LB (Metavir score) and FIB-4 index. We assessed overall death (OD) and liver-related events (LREs), defined as decompensation or hepatocellular carcinoma, whichever occurred first. We used receiver operating characteristic (ROC) curves to determine the ability of LB and FIB-4 to predict outcomes. We also assessed the association between advanced fibrosis-LB (F3 or greater) or FIB-4 (≥3.25)-and outcomes using multivariate Cox regression analysis.
  
  
  RESULTS
  The study sample comprised 903 patients (328 with sustained virologic response [SVR]). Baseline fibrosis by LB was as follows: F0, n = 71; F1, n = 242; F2, n = 236; F3, n = 236; F4, n = 118. Fibrosis by FIB-4 was as follows: ≤1, n = 148; >1 to <3.25, n = 597; ≥3.25, n = 158. After a median follow-up of 62 months, there were 46 deaths and 71 LREs. The area under the ROC curves for OD/LREs was 0.648 and 0.742 for LB and FIB-4, respectively (P = .006). Similar results were found for patients without SVR and for OD and LREs separately. The adjusted hazard ratios of OD or LRE were 1.740 (95% confidence interval [CI], 1.119-2.7.06; P = .014) for advanced fibrosis assessed by LB and 3.896 (95% CI, 2.463-6.160; P < .001) assessed by FIB-4.
  
  
  CONCLUSIONS
  FIB-4 outperformed LB as a predictor of OD and LRE. These findings are of relevance for clinical practice and research and call into question the role of LB as a gold standard for assessing prognosis in HIV/HCV coinfection.
authors.affiliation: Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM).
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
authors.affiliation: Hospital Universitario La Paz Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid.
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Zamora
authors.affiliation: Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM).
authors.forename: Teresa
authors.initials: T
authors.lastname: Aldámiz-Echevarría
authors.affiliation: Hospital Donostia, San Sebastián.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Von Wichmann
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona.
authors.forename: Manel
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Hospital Universitario La Fe, Valencia.
authors.forename: José
authors.initials: J
authors.lastname: López-Aldeguer
authors.affiliation: Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM).
authors.forename: Ana
authors.initials: A
authors.lastname: Carrero
authors.affiliation: Hospital Universitario La Paz Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid.
authors.forename: Marisa
authors.initials: M
authors.lastname: Montes
authors.affiliation: Hospital Universitario Ramón y Cajal.
authors.forename: Carmen
authors.initials: C
authors.lastname: Quereda
authors.affiliation: Hospital Clínico San Carlos, Madrid.
authors.forename: María J
authors.initials: MJ
authors.lastname: Téllez
authors.affiliation: Hospital Clínico Universitario, Valencia.
authors.forename: María J
authors.initials: MJ
authors.lastname: Galindo
authors.affiliation: Hospital Universitario Príncipe de Asturias, Alcalá de Henares.
authors.forename: José
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Hospital Universitario de La Princesa, Madrid.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Santos
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Guardiola
authors.affiliation: Hospital Universitario de Móstoles.
authors.forename: Carlos
authors.initials: C
authors.lastname: Barros
authors.affiliation: Hospital General Universitario, Valencia.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ortega
authors.affiliation: Hospital Universitario 12 de Octubre Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid.
authors.forename: Federico
authors.initials: F
authors.lastname: Pulido
authors.affiliation: Hospital Universitario 12 de Octubre Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.affiliation: Hospital Clinic, Barcelona.
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.affiliation: Hospital Universitario Severo Ochoa, Leganés.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Jusdado
authors.affiliation: Hospital Universitario de Getafe.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pérez
authors.affiliation: Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM).
authors.forename: Cristina
authors.initials: C
authors.lastname: Díez
authors.affiliation: Hospital Universitario La Paz Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid.
authors.forename: Julio
authors.initials: J
authors.lastname: Álvarez-Pellicer
authors.affiliation: Fundación SEIMC-GESIDA, Madrid, Spain.
authors.forename: Herminia
authors.initials: H
authors.lastname: Esteban
authors.affiliation: Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM).
authors.forename: José M
authors.initials: JM
authors.lastname: Bellón
authors.affiliation: Hospital Universitario La Paz Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid.
authors.forename: Juan
authors.initials: J
authors.lastname: González-García
mesh_terms: D000328:Adult; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D008297:Male; D011379:Prognosis; D012372:ROC Curve
keywords: HIV; follow-up studies; hepatitis C; interferon; treatment outcome