Validation of a simple model for predicting liver fibrosis in HIV/hepatitis C virus‐coinfected patients

Abstract

ObjectivesRecently, several models incorporating laboratory measurements have been validated for use as surrogate markers for liver fibrosis in hepatitis C virus (HCV) mono-infection, the simplest of these being the aspartate aminotransferase (AST) to platelet ratio index (APRI). We evaluated how well the APRI predicts significant hepatic fibrosis in patients with HIV/HCV coinfection. MethodsForty-six HIV/HCV-coinfected patients who underwent liver biopsy and had concomitant laboratory measurements (AE3 months) were included in the study. Significant fibrosis was defined as F2-F4 using Batt and Ludwig scoring (53 Ishak). APRI 5 [(AST/upper limit of normal)/platelet count (10 9 /L)] Â100. We used SAS PROC LOGISTIC (SAS Institute, Cary, NC) to calculate the area under the receiver operating curve (ROC) (AUC). Sensitivities, specificities, positive predictive value (PPV) and negative predictive value (NPV) were compared using cut-offs previously identified in the literature. ResultsThirty-three of 46 patients (72%) had significant fibrosis on biopsy. For significant fibrosis, the area under the ROC for the APRI was 0.847 AE 0.057. APRI scores 41.5 (the higher cut-off) were 100% specific and 52% sensitive; PPV was 100% and NPV 45%. Scores o0.5 (the lower cut-off) were 82% sensitive and 46% specific in ruling out significant fibrosis (PPV 79%; NPV 50%). ConclusionsA simple model incorporating readily available laboratory data is highly predictive of significant fibrosis in HIV/HCV coinfection and could serve as a biopsy-sparing measure, thus making treatment more accessible for this population.

Hyperbilirubinemia during Atazanavir Treatment in 2,404 Patients in the Italian Atazanavir Expanded Access Program and MASTER Cohorts

“…Cox proportional hazards regression models were conducted to assess possible associations of the following factors with either grade ‡ III or IV hyperbilirubinemia: gender, age, risk factor for HIV acquisition, clinical class C {i.e., occurrence of major opportunistic infections according to the Centers of Disease Control (CDC'93) classification [7]), HCV-Ab and hepatitis B surface antigen (HBsAg) serostatus, CD4+ T-cell count and HIV-RNA at baseline (i.e., at initiation of ATV-containing regimens), baseline ALT, baseline bilirubinemia, aspartate aminotransferase (AST)/platelet ratio index (APRI)-score as a surrogate of the stage of liver disease [8], use of low-dose ritonavir, inclusion of other protease inhibitors (PIs) at active dosages in the regimens, and non-nucleoside reverse transcriptase inhibitors (NNRTI) or tenofovir (TDF) co-medications. The variables found to be significant (p < 0.2) by the univariate analysis were entered into multivariable models.…”

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

“…Nineteen studies included HCVmonoinfected patients (n ϭ 3,822), 17,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and 4 included HIV/HCV-co-infected patients (n ϭ 444). [48][49][50][51] Biopsy quality was considered acceptable in only 4 of the 22 studies. 51,53,57,63 According to the Quality Assessment of Diagnostic Accuracy Studies scale, the methodological quality of the included studies was very good.…”

“…Subsequently, numerous studies have attempted to externally validate these findings, but results have been controversial. 11,17,48 Differences in patient populations, including the prevalence of significant fibrosis, and reference ranges for AST, may explain these discrepancies.…”

HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality

“…not by CD4 cell criteria alone) [12]. The aspartate aminotransferase (AST) to platelet ratio index (APRI) was used as a noninvasive surrogate for liver fibrosis and defined as: 100 ¥ (AST/upper limit of normal)/platelet count (10 9 /L) [13,14]. An APRI score > 1.5 was considered to indicate significant fibrosis (corresponding to a biopsy score > F2) [14].…”