title: Transient Elastography for the Detection of Liver Damage in Patients with HIV.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) is effective and well tolerated, but hepatotoxicity is relatively common. Different non-invasive methods are available for detecting liver fibrosis in patients with chronic liver disease.
  
  
  METHODS
  Patients who were HIV positive and who had given their informed consent were included in this cross-sectional study. Transient elastography [FibroScan(®) (FS); Echosens], serum hyaluronic acid (HA), Hepascore (HS), Fibrosis-4 (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) were used to detect liver fibrosis in the patients. The agreement between FS and the other methods was evaluated. To observe the hepatotoxicity of HAART, patients with chronic viral hepatitis B or C were excluded by detection of hepatitis B surface antigens and hepatitis C virus antibodies. Patients with chronic alcohol intake were excluded by measuring carbohydrate-deficient transferrin (CDT). FS correlation with the duration of therapy with protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) was evaluated.
  
  
  RESULTS
  Overall, 203 patients were included in the study. The agreement between the different tests ranged from 64% to 77%: FS vs. HA, 72%; FS vs. APRI, 74%; FS vs. HS, 77%; and FS vs. FIB-4, 64%. After excluding patients with chronic hepatitis B or C and elevated CDT, 153 patients remained for studying the hepatotoxicity of HAART. A significant correlation of FS with the duration of medication intake was observed for PIs (P = 0.026; r = 0.18). NRTI and NNRTI therapy duration did not correlate with FS.
  
  
  CONCLUSIONS
  The agreement between FS and other tests ranged from 64% to 77%. A significant correlation was found between liver stiffness and the duration of therapy with PIs, which underlines the known hepatotoxicity of this substance group.
  
  
  BACKGROUND
  Heinz-Ansmann Foundation.
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany. sagirabdu@hotmail.com.|Bethesda Krankenhaus Duisburg, Duisburg, Germany. sagirabdu@hotmail.com.
authors.forename: Abdurrahman
authors.identifier: http://orcid.org/0000-0002-6315-3712
authors.initials: A
authors.lastname: Sagir
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Glaubach
authors.affiliation: Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Cologne, Germany.
authors.forename: Kurtulus
authors.initials: K
authors.lastname: Sahin
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Graf
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Erhardt
authors.affiliation: Augustinerinnen Hospital, Cologne, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Oette
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
keywords: FibroScan®; HIV; Hepatotoxicity; Highly active antiretroviral therapy (HAART); Liver; Transient elastography