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AIDS. 2003 Mar 28;17(5):721-5.

Serum biochemical markers accurately predict liver fibrosis in HIV and hepatitis C virus co-infected patients.

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1
Department of Hepatology and Gastroenterology, Hôpital La Pitié-Salpêtrière, Paris, France.

Abstract

OBJECTIVE:

Liver biopsy, the gold standard for assessing hepatitis C virus (HCV)-related fibrosis, is invasive and prone to complications. Our aim was to determine the operating characteristics of a non-invasive index of biochemical markers for the prediction of fibrosis in patients with HIV/HCV co-infection.

DESIGN:

In a cross-sectional, cohort study in a French tertiary-care hospital 130 HIV/HCV-co-infected patients with a liver biopsy and serum were tested for markers of liver fibrosis.

METHODS:

An index incorporating age, sex, alpha(2)-macroglobulin, apolipoprotein A1, haptoglobin, bilirubin, and gamma-glutamyl-transpeptidase (GGT), derived using multivariate logistic regression, was compared with liver histology. HIV-specific indices including the CD4 cell count and HIV-RNA load were also constructed. The diagnostic values of the indices were compared using receiver operating characteristic (ROC) curves.

MAIN OUTCOME MEASURE:

Septal fibrosis (F2-F4) by the METAVIR classification.

RESULTS:

By multivariate analysis, the most informative markers were alpha(2)-macroglobulin, apolipoprotein A1, GGT, and sex. The area under the ROC curve of the five-marker index was 0.856 +/- 0.035; not significantly different from the HIV-specific indices. On a scale from zero to 1.00, the five-marker index had a positive predictive value of 86% for scores greater than 0.60, and a negative predictive value of 93% for scores of 0.20 or less. These thresholds could reduce the necessity for liver biopsy by 55% while maintaining an accuracy of 89%.

CONCLUSION:

An index including five biochemical markers accurately predicts significant fibrosis in patients with HIV/HCV co-infection, and may substantially reduce the necessity for liver biopsy.

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