title: Diagnostic accuracy of APRI, FIB-4 and Forns for the detection of liver cirrhosis in HIV/HCV-coinfected patients.
abstract: We determined the diagnostic accuracy and optimal cut off of three indirect fibrosis biomarkers (APRI, FIB-4, Forns) compared with liver stiffness (LS) for the detection of liver cirrhosis in HIV/HCV-coinfected patients. An observational retrospective study on HIV/HCV-coinfected patients with concomitant LS measurement and APRI, FIB-4 and Forns was performed. The presence of liver cirrhosis was defined as a LS ≥13 KPa. The diagnostic accuracy and optimal cut-off values, compared with LS categorization (<13 vs ≥13 KPa), were determined by receiver operating characteristics (ROC) curves.
  The study sample included 646 patients. The area-under-the ROC curve (95% confidence interval) for the detection of liver cirrhosis were 0.84 (0.81-0.88), 0.87 (0.84-0.91) and 0.87 (0.84-0.90) for APRI, FIB-4 and Forns, respectively. According to the optimal cut off values for liver cirrhosis (≥0.97 for APRI, ≥2.02 for FIB-4 and ≥7.8 for Forns), 80%, 80% and 82% of subjects were correctly classified by the three indirect fibrosis biomarkers, respectively. Misclassifications were mostly due to false positive cases.
  The study suggests that indirect fibrosis biomarkers can help clinicians to exclude liver cirrhosis in the management of HIV/HCV co-infected patients, reducing the frequency of more expensive or invasive assessments.
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merli
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Galli
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Salpietro
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gianotti
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Messina
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Poli
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Morsica
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bagaglio
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cernuschi
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alba
authors.initials: A
authors.lastname: Bigoloni
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Uberti-Foppa
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
authors.affiliation: Infectious Diseases Clinic, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hasson
mesh_terms: D015415:Biomarkers / Q000097:blood; D060085:Coinfection; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers
keywords: Elastography; HIV; Hepatitis C; Liver cirrhosis; Liver fibrosis