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Assessment of liver disease (noninvasive methods)

Mehta, Shruti H.; Buckle, Geoffrey C.

Current Opinion in HIV and AIDS: November 2011 - Volume 6 - Issue 6 - p 465–471
doi: 10.1097/COH.0b013e32834b55c7
HIV and hepatitis C coinfection: Edited by Jürgen Rockstroh and Gail Matthews

Purpose of review The purpose of this review is to highlight new findings published in 2010–2011 related to noninvasive fibrosis assessment in HIV/hepatitis C virus (HCV) co-infected patients. Overall, in 2010–2011, 15 studies were published, of which two were excluded because they were published in languages other than English.

Recent findings Eleven studies focused on serum marker panels. Studies sought to validate established panels in HIV/HCV co-infected patients often by comparing multiple serum marker panels in the same population; establish new marker panels using combinations of markers used in previously validated panels; and develop new marker panels using novel methodology. Overall, all panels performed within similar ranges of diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AUROC) but the FibroMeter panel and its derivations achieved the highest performance. Four studies focused on transient elastography. Two studies confirmed its accuracy for identifying fibrosis and cirrhosis and two studies confirmed that misclassification rates are higher in the presence of elevated triglycerides and steatosis.

Summary Overall, performance of transient elastography appeared superior to the majority of serum marker panels for the detection of significant fibrosis and cirrhosis in HIV/HCV co-infected patients. Challenges of widespread application of transient elastography remain high misclassification in some subgroups, lack of standardized cut-points and lack of widespread availability. Panels that were newly developed in 2010–2011 specifically for HIV/HCV appeared to perform better than existing panels such as APRI and FIB-4; however, additional external validation will be needed to confirm their accuracy.

Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA

Correspondence to Shruti H. Mehta, Associate Professor, Department of Epidemiology, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6537, Baltimore, MD 21231, USATel: +1 443 287 3837; fax: +1 410 955 1383; e-mail: shmehta@jhsph.edu

© 2011 Lippincott Williams & Wilkins, Inc.