Background: Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected
individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but
both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives.
Objectives: Our study’s aim was to validate commonly used NIBMs for the assessment of liver fibrosis
in a cohort of Greek HIV-mono-infected patients.
Methods: Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria
HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases
levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement
with TE and thorough laboratory work up and medical history were acquired at study entry.
FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient.
Results: A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible
with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance
with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients
as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity
new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by
changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was
Conclusion: Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV
mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing
patients with significant from those with mild/no fibrosis.