title: Use of transient elastography in patients with HIV-HCV coinfection: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Patients with HIV-hepatitis C virus (HCV) coinfection progress towards liver fibrosis and cirrhosis more rapidly compared with HCV mono-infected individuals. This necessitates an accurate assessment of liver stiffness with transient elastography to guide treatment.
  
  
  METHODS
  Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were performed through January 2016 to assess the diagnostic accuracy of transient elastography for liver stiffness in the HIV-HCV population. Included studies were analyzed according to the Cochrane DTA Working Group methodology. Bivariate and hierarchical models were used to compute pooled sensitivity and specificity. Positive and negative likelihood ratios were also determined. A Fagan nomogram was constructed. Meta-regression analysis was performed with assessment of publication bias using Deeks' funnel plot asymmetry testing.
  
  
  RESULTS
  A total of six studies (n = 756) met the inclusion criteria. The diagnostic accuracy of elastography for the diagnosis of moderate (≥F2) fibrosis was 88% (95% confidence interval [CI], 0.85-0.90). The pooled sensitivity and specificity of moderate fibrosis was 97% (95% CI, 0.82-0.91) and 64% (95% CI, 0.45-0.79), respectively. The diagnostic accuracy of elastography for the assessment of cirrhosis was 94% (95% CI, 0.91-0.95). The pooled sensitivity and specificity for cirrhosis was 90% (95% CI, 0.74-0.97) and 87% (95% CI, 0.80-0.92), respectively. Meta-regression analysis demonstrated that CD4 cell count did not impact diagnostic accuracy of elastography.
  
  
  CONCLUSIONS
  Transient elastography is a noninvasive imaging modality with excellent ability to assess for cirrhosis in patients with HIV-HCV coinfection.
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. basile.njei@yale.edu.|Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, USA. basile.njei@yale.edu.
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: McCarty
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Luk
authors.affiliation: Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA.
authors.forename: Oforbuike
authors.initials: O
authors.lastname: Ewelukwa
authors.affiliation: Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ivo
authors.initials: I
authors.lastname: Ditah
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lim
mesh_terms: D060085:Coinfection / Q000000981:diagnostic imaging; D054459:Elasticity Imaging Techniques / Q000379:methods; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging*; D006526:Hepatitis C / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000821:virology; D012680:Sensitivity and Specificity
keywords: HCV; HIV; elastography; fibrosis; hepatitis