title: Association of HIV, Hepatitis C Virus, and Liver Fibrosis Severity With the Enhanced Liver Fibrosis Score.
abstract: BACKGROUND
  Liver disease is common during human immunodeficiency virus (HIV) infection, but valid serum fibrosis markers are lacking. We hypothesize that HIV monoinfection and HIV/hepatitis C virus (HCV) coinfection is associated with an enhanced liver fibrosis (ELF) score higher than that for uninfected controls and examine whether this association is affected by factors other than liver injury.
  
  
  METHODS
  The association of HIV and HIV/HCV coinfection with the ELF score was evaluated using multivariable regression after controlling for transient elastography-measured liver stiffness and traditional and HIV-related factors in a cross-sectional analysis of 297 women.
  
  
  RESULTS
  HIV/HCV-coinfected and HIV-monoinfected women had higher median ELF scores than controls (9.6, 8.5, and 8.2, respectively). After adjustment for demographic, behavioral, and metabolic factors and for inflammatory markers, HIV/HCV coinfection remained associated with a 9% higher ELF score (95% confidence interval [CI], 5%-13%), while the association of HIV monoinfection was substantially attenuated (1% higher ELF score; 95% CI, -2% to 4%). After further adjustment for liver stiffness, HIV/HCV coinfection remained associated with 6% higher levels (95% CI, 3%-10%). In HIV/HCV-coinfected and HIV-monoinfected women, higher liver stiffness values were associated with higher ELF scores, as were older age and a nadir CD4(+) T-cell count of <200 cells/mm(3).
  
  
  CONCLUSIONS
  Our findings suggest that the ELF score can be used to assess liver fibrosis severity in HIV-infected women. However, higher ELF scores may reflect extrahepatic fibrosis in HIV-infected patients with a history of severe immunosuppression or advanced age.
authors.affiliation: Department of Medicine, University of California Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California.
authors.forename: Sophia
authors.initials: S
authors.lastname: Swanson
authors.affiliation: Department of Pediatrics, University of California.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Medicine, University of California Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Scherzer
authors.affiliation: CORE Center, Stroger Hospital and Rush University, Chicago, Illinois Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois.
authors.forename: Greg
authors.initials: G
authors.lastname: Huhn
authors.affiliation: CORE Center, Stroger Hospital and Rush University, Chicago, Illinois Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois.
authors.forename: Audrey L
authors.initials: AL
authors.lastname: French
authors.affiliation: Department of Medicine, Georgetown University Medical Center, Washington D.C.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Plankey
authors.affiliation: Department of Medicine, University of California Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California.
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.affiliation: Institute for Liver and Digestive Health, Division of Medicine, University College London, United Kingdom.
authors.forename: William M
authors.initials: WM
authors.lastname: Rosenberg
authors.affiliation: Department of Medicine, University of California.
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
authors.affiliation: Department of Medicine, University of California Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus / Q000502:physiology; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012720:Severity of Illness Index; D019562:Viral Load
chemical_list: D012367:RNA, Viral
keywords: HCV; HIV; enhanced liver fibrosis score; transient elastography; women