Liver fibrosis progression in a cohort of young HIV and HIV/ HBV co-infected patients: A longitudinal study using non-invasive APRI and Fib-4 scores

Abstract

BackgroundThe risk of liver fibrosis increases over time in HIV and HIV-HBV individuals even under antiretroviral treatment (ART), warranting a rigorous and periodic monitorization. Given the lower availability of transient elastography, we aimed to assess the longitudinal variation of two non-invasive liver fibrosis scores, APRI and Fib-4, in cases with HIV monoinfection, HIV-HBV co-infection and individuals with HBsAg-seroclearance.MethodsWe performed an observational retrospective study between 2013 and 2019 on 212 HIV patients including 111 individuals with HIV mono-infection, 62 individuals with HIV-HBV co-infection and positive HBsAg and 39 cases with HIV-HBV infection and HBsAg-loss. The groups were followed at 36, 48, and 60 months. Liver fibrosis was indicated by an APRI >0.5 or Fib-4≥1.45 score and advanced fibrosis by an APRI score >1.5 or Fib-4 >3.25. Logistic regression with generalized estimating equations (GEE) was used to assess the predictors for the presence of liver fibrosis over time.ResultsDuring a median follow-up of 58.5 months the prevalence of liver fibrosis in all patients increased with 0.5% reaching 11.3% using an APRI score and with 0.9% reaching 10.8% using the Fib-4 score. At the visit corresponding to 60 months the prevalence of liver fibrosis was higher in all HIV-HBV patients compared with individuals with HIV mono-infection, namely: 16.1% on APRI and 12.9% on the Fib-4 score in HIV-HBV/HBsAg-positive individuals, 12.8% on both APRI and Fib-4 scores in HIV-HBV/HBsAg-negative individuals vs. 8.1 and 9%, respectively in HIV mono-infection. The presence of liver fibrosis over the study period was independently associated with plasma HIV RNA, CD4+T cell counts, HIV-HBV co-infection (for APRI >0.5) and ART non-adherence (for Fib-4 >1.45). At the final visit, non-adherence to ART and CD4+T cell counts remained associated with liver fibrosis.ConclusionsThe study found a slow progression of APRI and Fib-4 scores over time in young PLWH with extensive ART. Liver fibrosis scores continued to increase in patients with HIV mono-infection yet remained lower than in HIV-HBV patients irrespective on the presence of HBsAg. The periodic follow-up using non-invasive scores on the long-term could help improve the surveillance in low-income settings and high scores should be followed by additional diagnostic methods.

Efficacy, Convenience, Safety and Durability of DTG-Based Antiretroviral Therapies: Evidence from a Prospective Study by the Italian MaSTER Cohort

“…Thus, the condition of being naïve was associated with a higher probability of having detectable viremia after six months of follow-up compared to experienced people who already responded to treatment and in whom cART was previously optimized; (c) having higher HIV RNA at baseline, as already found in a previous work of the MaSTER cohort [7], pointing out the importance of carefully monitoring these people for HIV RNA, even those using DTG-containing regimens, who may run the risk of low level viremia after six months of treatment [14]; (d) FIB4 score > 3.25. Regarding this finding, the correlation between poor cART adherence and increased values of FIB4 score is known to grow in the eventuality of there being detectable viremia in people with liver fibrosis [15]. These findings provide further support to improve medical interventions and counseling with the aim of improving cART adherence in this population, minimizing the risk of virological failure.…”

HIV-HBV Coinfection—Current Challenges for Virologic Monitoring

“…Recent studies have shown that these scores are reliable noninvasive methods for the assessment of nonsignificant versus significant liver fibrosis in HIV-HBV coinfected patients also [127,128]. A FIB-4 value < 1.5 or APRI < 0.5 are concordant with Fibroscan results and can exclude fibrosis in 94.4% and 96.8% of cases [96].…”

FIB-4 is closer to FibroScan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning

“…For each patient, the AST/ALT ratio was measured and APRI and FIB-4 scores were determined using previously reported equations. [ 17 , 18 ]…”

“…For each patient, the AST/ALT ratio was measured and APRI and FIB-4 scores were determined using previously reported equations. [17,18] FibroScan 502 (2005), manufactured by Echosens (42Rue Monge 74005, Paris, France), was used in this study. The manufacturer guidelines and findings from previous studies have indicated that 10 valid FibroScan readings are necessary for a test to be deemed successful.…”