title: Prevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth.
abstract: OBJECTIVE
  To longitudinally characterize noninvasive markers of liver disease in HIV-infected youth.
  
  
  METHODS
  HIV infection, without viral hepatitis coinfection, may contribute to liver disease. Noninvasive markers of liver disease [FIB-4 (Fibrosis-4) and APRI (aspartate aminotransferase-to-platelet ratio index)] have been evaluated in adults with concomitant HIV and hepatitis C, but are less studied in children.
  
  
  METHODS
  In prospective cohorts of HIV-infected and HIV-uninfected youth, we used linear regression models to compare log-transformed FIB-4 and APRI measures by HIV status based on a single visit at ages 15-20 years. We also longitudinally modeled trends in these measures in HIV-infected youth with two or more visits to compare those with behavioral vs. perinatal HIV infection (PHIV) using mixed effect linear regression, adjusting for age, sex, body mass index, and race/ethnicity.
  
  
  RESULTS
  Of 1785 participants, 41% were men, 57% black non-Hispanic, and 27% Hispanic. More HIV-infected than uninfected youth had an APRI score more than 0.5 (13 vs. 3%, P < 0.001). Among 1307 HIV-infected participants with longitudinal measures, FIB-4 scores increased 6% per year (P < 0.001) among all HIV-infected youth, whereas APRI scores increased 2% per year (P = 0.007) only among PHIV youth. The incidence rates (95% confidence interval) of progression of APRI to more than 0.5 and more than 1.5 were 7.5 (6.5-8.7) and 1.4 (1.0-1.9) cases per 100 person-years of follow-up, respectively. The incidence of progression of FIB-4 to more than 1.5 and more than 3.25 were 1.6 (1.2-2.2) and 0.3 (0.2-0.6) cases per 100 person-years, respectively.
  
  
  CONCLUSIONS
  APRI and FIB-4 scores were higher among HIV-infected youth. Progression to scores suggesting subclinical fibrosis or worse was common.
authors.affiliation: aMaternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland bCenter for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts cTulane University Health Sciences Center, New Orleans, Louisiana dNew York University, New York, New York eSt. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Bill G
authors.initials: BG
authors.lastname: Kapogiannis
authors.forename: Erin
authors.initials: E
authors.lastname: Leister
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: Bret
authors.initials: B
authors.lastname: Rudy
authors.forename: Patricia
authors.initials: P
authors.lastname: Flynn
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology* / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D010976:Platelet Count; D015995:Prevalence; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases