647-M.
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Serum Biochemical Markers of Liver Fibrosis in HIV and HCV Co-Infected Patients
Y. Benhamou*, R. P. Myers, M. Bochet, F. Imbert-Bismut, V. Thibault, C. Katlama, and T. Poynard for the MULTIVIRC Group
Groupe Hosp. Pitié-Salpêtrière, Paris, France
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Background: Liver biopsy is the gold standard for assessing fibrosis in patients with chronic hepatitis C. In patients with isolated HCV infection, we have devised an index of biochemical markers with high predictive values for significant histologic lesions, but the utility of this index in patients with HIV/HCV co-infection is unknown. Objectives were to determine the operating characteristics of this 5-marker index in patients with HIV/HCV co-infection; and to determine the incremental diagnostic value of the CD4 count for the use of the index in HIV-co-infected patients.
Methods: 131 patients with HIV/HCV co-infection had a liver biopsy and serum tested for markers of liver fibrosis. Using multivariate analysis, an index incorporating age, gender, and 5 biochemical markers (total bilirubin, gamma-glutamyl-transpeptidase, alpha2-macroglobulin, apolipoprotein A1, and haptoglobin) was constructed for the diagnosis of clinically significant fibrosis (F2-F4 by the Metavir system). An additional index incorporated CD4 lymphocyte count. The diagnostic values of these indices were compared using areas under ROC curves and predictive values.
Results: The overall frequency of clinically significant fibrosis was 44% (58 patients). By multivariate logistic regression analysis, the most informative markers were alpha2-macroglobulin (p<0.0001), apolipoprotein A1 (p= 0.006), and the age at biopsy (p=0.03). The CD4 lymphocyte count and level of HIV viremia were not independently predictive of F2-F4 fibrosis when the biochemical markers were considered. For the discrimination of clinically significant fibrosis, the area under the ROC curve was 0.889 ± 0.031. With this index, a high positive predictive value (>90% certainty of a diagnosis of F2-F4) was obtained for scores from 0.80-1.00, and a high negative predictive value (>90% certainty of the absence of F2-F4) for scores from 0-0.20. The operating characteristics of an index including CD4 count did not differ significantly from the 5-marker index.
Conclusions: An index of 5 basic biochemical markers accurately predicts significant fibrosis in patients with HIV/HCV co-infection, and can substantially reduce the necessity of liver biopsies in this population.
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