913 
Biochemical Scores for Liver Fibrosis in HIV/HBV-co-infected Patients: Accuracy in Detecting Cirrhosis but Not Mild or Bridging Fibrosis
Karine Lacombe*1,2, Karine Lacombe*1,2, V Massari2, J Guéchôt1, D Wendum1, M Chevallier3, P Callard4, L Serfaty1, G Pialoux4, J M Molina5, and P M Girard1
1Hosp St Antoine, Paris, France; 2INSERM U707, Univ Pierre and Marie Curie, Paris, France; 3Hotel-Dieu, Lyon, France; 4Hosp Tenon, Paris, France; and 5Hosp St Louis, Paris, France
Background: Surrogate markers to assess liver fibrosis,
such as biochemical scores, might be useful
in patients with chronic hepatitis. However, the accuracy of such tools
has not been evaluated in HIV/hepatitis B virus (HBV) -co-infected patients.
Methods: A cross-sectional analysis on a panel of
biochemical markers, measured at the time of liver biopsy, was performed in HIV/HBV-co-infected
patients recruited in an HIV/HBV French cohort study. Patients with hepatitis-C-co-infection
were excluded. In this study population, 10 published scores validated in HBV- or
HCV-mono-infected patients or HIV/HVC-co-infected patients were calculated (Fibrotest,
SHASTA, Hepascore, Zeng, Forns, Apri, hyaluronic acid, AST/ALT, FIB4, SNIFF7). For
each biochemical score and liver biopsy, the level of fibrosis was dichotomized
as follows: no or very mild fibrosis (Metavir F0-F1) vs mild/bridging
fibrosis/cirrhosis (Metavir F2-F3-F4); and no or mild or bridging fibrosis
(F0-F1-F2-F3) vs cirrhosis (F4). The
area under the curve (AUC) was calculated for each test and the corresponding
confidence intervals were calculated by a bootstrap procedure. AUC were
compared using non-parametric tests.
Results: We included in the study, 55 patients with a
mean age of 40.5 years, of whom 23 were classified F0-F1 vs 32 with F2-F3-F4,
and 43 were classified with F0-F1-F2-F3 vs 12 with F4. Cirrhosis was accurately
diagnosed with, by increasing performance, Forns (AUC = 0.80), hyaluronic acid
(AUC = 0.82), Zeng (AUC = 0.83), Hepascore (AUC = 0.83), SHASTA (AUC = 0.88),
and SNIFF7 (AUC = 0.88). All other tests had an AUC <0.80 (eg, Fibrotest,
AUC = 0.75). However, no test could accurately differentiate F0-F1 from
F2-F3-F4 (all AUC <0.75).
Conclusions: In
HIV/HBV-co-infected patients, 6 biochemical scores accurately diagnosed
cirrhosis. However, no score had an AUC significantly higher than that of
hyaluronic acid, an easy-to-measure, single marker. No score had enough power
to differentiate the F1 from the F2 stage, which is an indicator for treatment.
Liver biopsy may still be the “gold standard” to assess fibrosis in HIV/HBV-co-infected
patients.
|
