title: Transient elastography for the detection of hepatic fibrosis in HIV-monoinfected adults with elevated aminotransferases on antiretroviral therapy.
abstract: OBJECTIVE
  Vibration-controlled transient elastography (VCTE) is increasingly used to assess liver fibrosis in viral hepatitis and fatty liver disease populations. Because the accuracy of VCTE in HIV-monoinfected populations has not been established, we evaluated its performance in assessing liver fibrosis in a cohort of HIV-monoinfected adults undergoing liver biopsy as part of a recently published clinical trial.
  
  
  METHODS
  HIV-infected adults with elevated aminotransferase levels for at least 6 months while receiving antiretroviral therapy, and without chronic viral hepatitis or other known causes of liver disease, were prospectively evaluated by VCTE, other noninvasive markers of fibrosis, and percutaneous liver biopsy as part of a cross-sectional study examining liver pathology.
  
  
  RESULTS
  Sixty-six patients were evaluated by VCTE and liver biopsy. The cohort was in the majority male (92%), with a median age of 50 years (range 17-68). Biopsy identified bridging fibrosis in 14 (21%) and nonalcoholic steatohepatitis in 38 (58%) participants. VCTE was unsuccessful or unreliable in seven participants (11%). In the 59 participants with reliable results, median liver stiffness measurement (LSM) was 5.9 kPa (range 3.3-29.2 kPa); 25 participants (42%) had a LSM above 7.1 kPa, a value consistent with increased liver stiffness in other populations. VCTE had good sensitivity and specificity with an area under the receiver-operating characteristic curve (AUROC) of 93% for detection of moderate fibrosis (Ishak F ≥ 2; 95% confidence interval 86-99%).
  
  
  CONCLUSIONS
  In HIV-monoinfected adults with biopsy-proven liver disease, LSM by VCTE was the best noninvasive predictor of fibrosis. Our findings support the continued use of VCTE for fibrosis screening in HIV-monoinfected patients with elevated aminotransferases.
authors.affiliation: aNIH Clinical Center, Critical Care Medicine Department, AIDS Section bNational Institute of Allergy and Infectious Diseases, Laboratory of Immunoregulation cNational Institute of Allergy and Infectious Diseases, Biostatistics Research Branch dNational Cancer Institute, Laboratory of Pathology eNational Institute of Diabetes and Digestive and Kidney Diseases, Liver Diseases Branch, Bethesda, Maryland, USA.
authors.forename: Caryn G
authors.initials: CG
authors.lastname: Morse
authors.forename: Mary
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Michael
authors.initials: M
authors.lastname: Proschan
authors.forename: Christopher
authors.initials: C
authors.lastname: Koh
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Theo
authors.initials: T
authors.lastname: Heller
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kovacs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000637:Transaminases / Q000097:blood*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000637:Transaminases