title: Progression of Liver Fibrosis in HIV/HCV Co-Infection: A Comparison between Non-Invasive Assessment Methods and Liver Biopsy.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of seven non-invasive tests (NITs) of liver fibrosis and to assess fibrosis progression over time in HIV/HCV co-infected patients.
  
  
  METHODS
  Transient elastography (TE) and six blood tests were compared to histopathological fibrosis stage (METAVIR). Participants were followed over three years with NITs at yearly intervals.
  
  
  RESULTS
  Area under the receiver operating characteristic curve (AUROC) for significant fibrosis (> = F2) in 105 participants was highest for TE (0.85), followed by FIB-4 (0.77), ELF-Test (0.77), APRI (0.76), Fibrotest (0.75), hyaluronic acid (0.70), and Hepascore (0.68). AUROC for cirrhosis (F4) was 0.97 for TE followed by FIB-4 (0.91), APRI (0.89), Fibrotest (0.84), Hepascore (0.82), ELF-Test (0.82), and hyaluronic acid (0.79). A three year follow-up was completed by 87 participants, all on antiretroviral therapy and in 20 patients who completed HCV treatment (9 with sustained virologic response). TE, APRI and Fibrotest did not significantly change during follow-up. There was weak evidence for an increase of FIB-4 (mean increase: 0.22, p = 0.07). 42 participants had a second liver biopsy: Among 38 participants with F0-F3 at baseline, 10 were progessors (1-stage increase in fibrosis, 8 participants; 2-stage, 1; 3-stage, 1). Among progressors, mean increase in TE was 3.35 kPa, in APRI 0.36, and in FIB-4 0.75. Fibrotest results did not change over 3 years.
  
  
  CONCLUSIONS
  TE was the best NIT for liver fibrosis staging in HIV/HCV co-infected patients. APRI-Score, FIB-4 Index, Fibrotest, and ELF-Test were less reliable. Routinely available APRI and FIB-4 performed as good as more expensive tests. NITs did not change significantly during a follow-up of three years, suggesting slow liver disease progression in a majority of HIV/HCV co-infected persons on antiretroviral therapy.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmid
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bregenzer
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Milo
authors.initials: M
authors.lastname: Huber
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Berne, Berne, Switzerland.
authors.forename: Andri
authors.initials: A
authors.lastname: Rauch
authors.affiliation: Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jochum
authors.affiliation: Division of Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Vernazza
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Milos
authors.initials: M
authors.lastname: Opravil
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D060085:Coinfection / Q000821:virology; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery / Q000821:virology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers