A Cross-Sectional Epidemiological Study of Chronic HCV Liver Disease Stage in HIV-Coinfected Patients Using Noninvasive Techniques. CoTrans- GEENI Study

R.      Ramirez; S.      Valero; C.      Escrich; J.      Cucurull; A.      Tapiz; E.      Pedrol; the      Cotrans-GEENI Study Group

Abstract

Background & Aims: Considering the disadvantages of liver biopsy, alternative noninvasive methods have been sought to assess the stage of liver fibrosis. The aim of this study is to determine the prevalence of different stages of chronic liver disease using noninvasive methods (transition elastography (Fibroscan®) and Forns and AST-to-platelet ratio index–APRI-indexes) in HCV/HIV-coinfected patients.

Materials & Methods: An observational, cross-sectional, multicenter study conducted between September 2007 and May 2008. The study enrolled coinfected patients who had a transient elastography performed in the year of the study and/or biochemical markers (Forns/APRI indexes) to assess the stage of liver fibrosis.

Results: A total of 109 patients were finally enrolled. Mean elastography velocity was 15.3 kPa, and mean APRI and Forns indexes were 1.4 and 6.1, respectively. According to transient elastography: 41% had mild, 24% moderate, and 35% severe fibrosis; 35% with significant fibrosis. According to the APRI index: 29% had mild, 45% moderate, and 26% severe fibrosis; 28% with significant fibrosis. According to the Forns index: 16% had mild, 54% moderate, and 30% severe fibrosis; 30% with significant fibrosis. The Kappa concordance index between the three methods was 0.42 for fibrosis stage and 0.52 for significant fibrosis detection (p<0.001 in both cases).

Conclusions: There is concordance between the APRI and Forns indexes and elastography in the detection of different fibrosis stages and it is significant. Transient elastography agrees with these indexes in the detection of significant and severe fibrosis.

Keywords: Liver fibrosis, noninvasive methods, transient elastography, HCV/HIV coinfection, disease, CD4+, cell count, patients, chronic, platelet