Specific Biomarkers of Liver Fibrosis Suboptimal in HIV/HCV Coinfection

liver fibrosis tool
liver fibrosis tool
APRI and FIB-4 biomarkers may be unsatisfactory for the detection of significant fibrosis and cirrhosis in people with HIV and HCV.

Aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) biomarkers may be unsatisfactory for the detection of significant fibrosis and cirrhosis in people with HIV and HCV coinfection, according to a study recently published in Infection.

Noninvasive methods to evaluate liver fibrosis are performed broadly and have nearly replaced liver biopsy in the management of patients with viral hepatitis. These existing noninvasive methods are commonly used in patients with HIV/hepatitis C (HCV) coinfection in clinical practice. Treatment guidelines place substantial importance on estimating the degree of liver fibrosis accurately because this has significant effect on both treatment strategies and prognosis in patients with liver disease. Transient elastography is a well-validated, noninvasive test of fibrosis; however, it is not widely available and a simplified method of management of HCV monoinfection and HIV/HCV coinfection is needed. APRI and FIB-4 are 2 of the most validated indirect biomarkers of liver fibrosis and may serve as diagnostic tools. Therefore, this observational, retrospective study sought to assess the diagnostic reliability of these 2 biomarkers for the staging of liver fibrosis in people coinfected with HIV/HCV compared with their diagnostic reliability in those with HCV monoinfection. Transient elastography was used as a reference standard.  

From 2013 to 2016, subjects who had access to the RESIST HCV network comprising 22 hospitals and academic centers throughout Sicily were included. A total of 238 patients with HIV/HCV coinfection and 1937 with HCV monoinfection were included. Receiver operator characteristics curves measured the sensitivity, specificity, and diagnostic accuracy of APRI and FIB-4 as measurements for liver stiffness; values <9.5 kPa were categorized as significant fibrosis and those ³12.5 kPa demonstrated cirrhosis.

Unlike previous studies, results of the current study showed that APRI and FIB-4 were unreliable for the assessment of liver fibrosis in both HCV monoinfection and HIV/HCV coinfection. The diagnostic performance of both biomarkers showed suboptimal results in both ruling out significant fibrosis and in the assessment of cirrhosis. Use of these biomarkers resulted in very high false-negative and false-positive rates among both cohorts of subjects.

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Overall, the study authors concluded that, “Consequently, [transient elastography] remains essential for an adequate risk assessment of disease progression, hepatic decompensation, and death, and currently it cannot be replaced, according to our results, by serological markers.”


Mazzola G, Adamoli L, Calvaruso V, et al. Suboptimal performance of APRI and FIB-4 in ruling out significant fibrosis and confirming cirrhosis in HIV/HCV co-infected and HCV mono-infected patients [published online December 5, 2018]. Infection. doi: 10.1007/s15010-018-1258-6