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Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection†‡
Open accessAbstract
Liver biopsy remains the gold standard in the assessment of severity of liver disease. Noninvasive tests have gained popularity to predict histology in view of the associated risks of biopsy. However, many models include tests not readily available, and there are limited data from patients with HIV/hepatitis C virus (HCV) coinfection. We aimed to develop a model using routine tests to predict liver fibrosis in patients with HIV/HCV coinfection. A retrospective analysis of liver histology was performed in 832 patients. Liver fibrosis was assessed via Ishak score; patients were categorized as 0-1, 2-3, or 4-6 and were randomly assigned to training (n = 555) or validation (n = 277) sets. Multivariate logistic regression analysis revealed that platelet count (PLT), age, AST, and INR were significantly associated with fibrosis. Additional analysis revealed PLT, age, AST, and ALT as an alternative model. Based on this, a simple index (FIB-4) was developed: age ([yr] x AST [U/L]) / ((PLT [10(9)/L]) x (ALT [U/L])(1/2)). The AUROC of the index was 0.765 for differentiation between Ishak stage 0-3 and 4-6. At a cutoff of <1.45 in the validation set, the negative predictive value to exclude advanced fibrosis (stage 4-6) was 90% with a sensitivity of 70%. A cutoff of >3.25 had a positive predictive value of 65% and a specificity of 97%. Using these cutoffs, 87% of the 198 patients with FIB-4 values outside 1.45-3.25 would be correctly classified, and liver biopsy could be avoided in 71% of the validation group. In conclusion, noninvasive tests can accurately predict hepatic fibrosis and may reduce the need for liver biopsy in the majority of HIV/HCV-coinfected patients.
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“It includes HIV-1 RNA, CD4 count, hepatitis C co-infection, FIB 4, eGFR, anemia, and age and is substantially more predictive of all causes of mortality than an index restricted to HIV-1 RNA, CD4 count, and age.”
From HIV and Aging: State of Knowledge and Areas of Critical Need for Research. A Report to the NIH Office of AIDS Research by the HIV and Aging Working Group (2012) · cites this paper as [56]
In the citing paper
“These composite markers of liver injury have been repeatedly shown to indicate risk of liver fibrosis among those with HIV and HCV infections (56).”
From HIV and Aging: State of Knowledge and Areas of Critical Need for Research. A Report to the NIH Office of AIDS Research by the HIV and Aging Working Group (2012) · cites this paper as [56]
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Metadata
- Authors
- Sterling, R. K., Lissen, E., Clumeck, N., Sola, R., Correa, M. C., Montaner, J., S. Sulkowski, M., Torriani, F. J., Dieterich, D. T., Thomas, D. L., Messinger, D., & Nelson, M.
- Affiliations
- Virginia Commonwealth University (US)
- James J. Peters VA Medical Center (US)
- Centre Hospitalier Universitaire de Saint-Pierre (BE)
- Universitat Autònoma de Barcelona (ES)
- University of British Columbia (CA)
- University of California San Diego (US)
- Icahn School of Medicine at Mount Sinai (US)
- Johns Hopkins University (US)
- Chelsea and Westminster Hospital (GB)
- Corresponding author
- Sterling, Richard K.
- Venue
- Hepatology
- Published
- 2006-06
- Volume
- 43
- Issue
- 6
- Pages
- 1317-1325
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2064387090
- Cited by
- 5,021
- References
- 48
- Citations by year
- 2026: 497 · 2025: 523 · 2024: 523 · 2023: 490 · 2022: 492 · 2021: 494 · 2020: 390 · 2019: 333 · 2018: 239 · 2017: 210 · 2016: 204 · 2015: 158 · 2014: 92 · 2013: 83 · 2012: 67
- FWCI
- 29.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Funders
- National Institute on Drug Abuse (R01DA016078)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK064578)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Keywords
- HIV/HCV coinfection, liver fibrosis, FIB-4, liver biopsy avoidance, platelet count, transaminases, international normalized ratio, Ishak score, fibrosis staging
- MeSH terms
- Age Factors, Biopsy, Needle, Blood Chemical Analysis, Diagnostic Tests, Routine, Female, Humans, Immunohistochemistry, Liver Cirrhosis, Liver Function Tests, Male, Predictive Value of Tests, Probability, Prognosis, Retrospective Studies, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Sex Factors, Reproducibility of Results, Cohort Studies, HIV Infections, Logistic Models, Disease Progression, Risk Assessment, Hepatitis C, Chronic
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