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Curr HIV/AIDS Rep. 2016 Oct;13(5):279-88. doi: 10.1007/s11904-016-0329-5.

Use of Non-invasive Testing to Stage Liver Fibrosis in Patients with HIV.

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Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
Division of General Internal Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei City, Taiwan.
Toronto Centre for Liver Disease, University Health Network Toronto, Toronto, ON, Canada.
University of Toronto, Toronto Centre for Liver Disease, Toronto General Hospital, Eaton North, 9th floor Room 232, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.


Patients with HIV have a proclivity to develop liver fibrosis, especially when associated with other conditions such as HCV, HBV, and NAFLD. Identifying HIV-infected patients with significant fibrosis or cirrhosis plays an important role in clinical and therapeutic decision-making. Liver biopsy is currently considered as the gold standard for fibrosis assessment but carries many shortcomings (cost, invasiveness, complications, false negative rate of 20 %). Multiple non-invasive methods of liver fibrosis assessment have been developed, but not all have been studied in HIV-infected individuals. Non-invasive liver fibrosis tools include both serologic-based testing scores (rely on direct and/or indirect markers) such as APRI, FIB4, FibroTest, FibroSpect II, HepaScore, or imaging-based methods such as vibration controlled liver elastography. There is validated data to support the use of non-invasive modalities of fibrosis assessment in HIV-HCV co-infected individuals for the exclusion of cirrhosis, but may be poorly reliable or not enough data exists for the assessment of other co-morbid disease processes.


Biomarkers; HIV non-alcoholic fatty liver disease; HIV-hepatitis B; HIV-hepatitis C; Liver fibrosis; Transient elastography

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