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017

NONINVASIVE ASSESSMENT OF FIBROSIS IN PATIENTS WITH HIV/HCV COINFECTION: A SYSTEMATIC REVIEW OF SERUM BIOCHEMICAL MARKERS AND FIBROSCAN®

AM Shaheen, RP Myers
Liver Unit, University of Calgary, Calgary, Alberta

INTRODUCTION: Fibrosis progression is accelerated in HIV-coinfected patients. While liver biopsy is the gold standard for assessing fibrosis, noninvasive alternatives, including biochemical markers and the FibroScan®, have gained widespread use. Our objective was to determine the accuracy of these measures for the prediction of fibrosis in HIV/HCV-coinfected patients.
METHODS: MEDLINE, EMBASE and Cochrane databases were searched (through June 2006) for studies assessing composite indices of biochemical markers (FibroTest®, FORNS, APRI, SHASTA) or FibroScan® for the prediction of fibrosis in HIV/HCV-coinfected patients. Studies with <30 subjects (n=3) were excluded. Random-effects summary receiver operating characteristic (SROC) curves were used to assess performance of the measures.
RESULTS: 6 studies including 646 patients (77% male, mean age: 40 yrs), were included. All 6 studies assessed biochemical indices and 1 assessed the FibroScan® to distinguish significant fibrosis (Ishak=>F3 or METAVIR=>F2). Four studies assessed FibroTest®, APRI, FORNS and FibroScan® to detect cirrhosis (Ishak=>F5 or METAVIR=F4). Significant fibrosis and cirrhosis were present in 46% and 17%, respectively. For all measures, the area under the SROC curve (AUC) for significant fibrosis and cirrhosis were 0.80 (95% CI 0.77-0.83) and 0.78 (0.73-0.82), respectively. Individual AUCs for each index are summarized in Table 1.
                                           

Table 1: AUCs for fibrosis measures in HIV/HCV-coinfected patients
Index	Sig. Fibrosis	N (Trials)	Cirrhosis	N (Trials)
APRI +	0.80 (0.60-0.92)	309 (2)	0.78 (0.72-0.84)	303 (2)
FORNS *	0.77 (0.71-0.83)	263 (1)	0.81 (0.65-0.97)	40 (1)
FibroTest® *	0.86 (0.79-0.93)	130 (1)	0.87 (0.76-0.98)	130 (1)
SHASTA *	0.88 (0.84-0.91)	95 (1)	--	--
FibroScan® *	0.72 (0.6-0.84)	72 (1)	0.97 (0.94-1.00)	72 (1)
+AUC by SROC analysis. *AUC as reported in the original study.


CONCLUSION: Currently available noninvasive measures of fibrosis appear to have acceptable accuracy in HIV/HCV-coinfected patients. However, additional studies in larger cohorts of patients are required to determine the optimal measure.

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