Evaluation of hepatic fibrosis in HIV/HCV co-infected individuals in Yaoundé, Cameroon: usefulness of APRI score in resource-constrained settings

Abstract

Background HIV infection exacerbates the prognosis of HCV infection, with a faster progression of hepatitis. Hepatic fibrosis is the major disruption of the hepatic tissue architecture characterized by anarchic deposition and excess of the extracellular matrix. The objective of this study was to evaluate hepatic fibrosis in HIV/HCV co-infected individuals as compared to HCV mono-infected. Methods A total of 97 participants (mean age 60.2 ± 14.3 years and 0.76 male/female sex ratio) was enrolled in a study conducted in Yaoundé, Cameroon from November 2018 to January 2019. Liver fibrosis was assessed by the APRI score (Aspartate Aminotransferase or AST/Platelet Ratio Index) which identifies the stage of fibrosis as classified by the Metavir system (F0 to F4). CD4 counts and plasmatic HIV viral load of HIV/HCV co-infected individuals were determined and the correlation between hepatic fibrosis and immuno-virological status established. Statistical analysis was done using Microsoft Excel 2016 and EpiInfo7 software. Results A high proportion (63.6%) of HIV/HCV co-infected participants had an abnormal AST level: 73.6 ± 45.8 IU/L as compared to 58.5 ± 39.3 IU/L (59.3%) among HCV mono-infected participants. The frequency of thrombocytopenia was 63.6% with a mean platelet count of 137 ± 50 × 103 IU/L in HIV/HCV co-infected participants as compared to 176 ± 67 × 103 IU/L in HCV mono-infected participants (38.4%). The progression of hepatic fibrosis in participants with clinically significant fibrosis: F2, F3 and F4 was higher among HIV/HCV co-infected and the mean APRI score was 1.7 ± 1.4 versus 1 ± 0.8 among HCV mono-infected (26.7%). All participants (100%) with detectable HIV viral load had clinically significant fibrosis compared to 33.4% in those with undetectable HIV viral load (p = 0.55). Only 42.9% participants with CD4 > 500 cells/μL had clinically significant fibrosis (p = 0.72) while 100% participants with CD4 < 200 cells/μL had clinically significant fibrosis (p = 0.58). Conclusions A high level of AST combined with thrombocytopenia (APRI score > 1.5) is an indicator of hepatic fibrosis in HIV/HCV co-infected individuals. Because of its non-invasive and less costly nature, the APRI score can be a suitable biomarker to monitor hepatic fibrosis in HIV/HCV co-infected individuals in resource constrained settings.

Indirect serum biomarkers perform sub optimally in screening for significant liver fibrosis among HIV-infected and uninfected adults in Uganda

“…We found a high negative predictive value and low positive predictive for all the indirect serum bio-markers similar to other studies 11,13,18 . For all the serum bio-markers the inter-observer agreement with Fibroscan® for the diagnosis of significant liver fibrosis was poor and for some almost by chance.…”

“…In addition, within the sub Saharan African region, the limited studies on the validation of these indirect serum biomarkers in an African population, have evaluated their use in single disease conditions, mainly viral hepatitis, and their remains disparity in their performance. There is strong recommendation for more similar studies in the region to inform on threshold values for these indirect serum bio-markers when applied to various liver disease entities 11,13 . Furthermore, available recommendations for the use of indirect serum bio-markers by World Health Organization in locations with limited access to the Fibroscan® mainly focuses on use of APRI among persons with chronic hepatitis B yet there is an increase in risk factor profile for chronic liver disease in the region presently for which the use of APRI may not necessary be suited.…”

Sofosbuvir plus Ribavirin is effective for HCV elimination in people living with HIV from rural area of China

“…Non-invasive methods of serum biomarker panels were reported to be less accurate for liver fibrosis and cirrhosis assessment in HIV–HCV coinfected patents 19 , 20 , but transient elastography was not accessible in this region. Instead, we adopted aspartate aminotransferase (AST)-to-platelet index (APRI) in collaboration with fibrosis 4 (FIB-4) scores to assess livers stiffness with higher sensitivity and specificity 21 , 22 . Advanced liver fibrosis, which would easily progress to cirrhosis, and liver cirrhosis was considered when patients had an APRI score above 1.0 and a FIB-4 score above 3.25.…”

HIV-Infected Hepatic Stellate Cells or HCV-Infected Hepatocytes Are Unable to Promote Latency Reversal among HIV-Infected Mononuclear Cells

“…Numerous studies have shown that HIV infection speeds up the progression of hepatic fibrosis caused by HCV infection. The mechanisms behind the accelerated hepatic fibrosis in individuals co-infected with HIV and HCV remain unclear but are likely multifaceted, involving factors such as direct viral impact, immune/cytokine dysregulation, and heightened oxidative stress [ 14 , 15 , 16 ].…”