title: Biochemical non-invasive assessment of liver fibrosis cannot replace biopsy in HIV-HCV coinfected patients.
abstract: OBJECTIVE
  The liver biopsy has been considered the gold standard for the diagnosis and quantification of fibrosis. However, this method presents limitations. In addition, the non-invasive evaluation of liver fibrosis is a challenge. The aim of this study was to validate the fibrosis cirrhosis index (FCI) index in a cohort of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, and compare to AST/ALT ratio (AAR), AST to platelet ratio index (APRI) and FIB-4 scores, as a tool for the assessment of liver fibrosis in coinfected patients.
  
  
  METHODS
  Retrospective cross sectional study including 92 HIV-HCV coinfected patients evaluated in two reference centers for HIV treatment in the Public Health System in Southern Brazil. Patients who underwent liver biopsy for any indication and had concomitant laboratory data in the 3 months prior to liver biopsy, to allow the calculation of studied noninvasive markers (AAR, APRI, FIB-4 and FCI) were included.
  
  
  RESULTS
  APRI < 0.5 presents the higher specificity to detect no or minimal fibrosis, whereas APRI > 1.5 presents the best negative predictive value and FCI > 1.25 the best specificity to detect significant fibrosis. The values of noninvasive markers for each Metavir fibrosis stage showed statistically significant differences only for APRI. In conclusion, until better noninvasive markers for liver fibrosis are developed and validated for HIV-HCV coinfected patients, noninvasive serum markers should be used carefully in this population.
authors.affiliation: Post-Graduate Program: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
authors.forename: Dimas A
authors.initials: DA
authors.lastname: Kliemann
authors.affiliation: Postgraduate Program Studies in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Fernando H
authors.initials: FH
authors.lastname: Wolff
authors.affiliation: Post-Graduate Program: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
authors.forename: Cristiane V
authors.initials: CV
authors.lastname: Tovo
authors.affiliation: Therapeutic Attention Service, Sanatorio Partenon Hospital, Brazil.
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Alencastro
authors.affiliation: Therapeutic Attention Service, Sanatorio Partenon Hospital, Brazil.
authors.forename: Maria L R
authors.initials: ML
authors.lastname: Ikeda
authors.affiliation: Post-Graduate Program: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
authors.forename: Ajácio B M
authors.initials: AB
authors.lastname: Brandão
authors.affiliation: Therapeutic Attention Service, Sanatorio Partenon Hospital, Brazil.
authors.forename: Nêmora
authors.initials: N
authors.lastname: Barcellos
authors.affiliation: Postgraduate Program Studies in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Fuchs
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004796:Clinical Enzyme Tests; D060085:Coinfection; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase