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15 October 2007

Volume 45, Number 8
Clinical Infectious Diseases 2007;45:969–974
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4508-0005$15.00
DOI: 10.1086/521857
MAJOR ARTICLE

The Use of Transient Elastometry for Assessing Liver Fibrosis in Patients with HIV and Hepatitis C Virus Coinfection

Salvador Vergara,1

Juan Macías,1

Antonio Rivero,5

Alicia Gutiérrez‐Valencia,3

Mercedes González‐Serrano,6

Dolores Merino,7

Mª José Ríos,4

José Angel García‐García,1

Angela Camacho,5

Luis López‐Cortés,3

Josefa Ruiz,6

Julián de la Torre,5

Pompeyo Viciana,3 and

Juan A. Pineda2;

for the Grupo para el Estudio de las Hepatitis Víricas de la SAEI

1Clinical Unit of Infectious Diseases, Department of Internal Medicine, and 2Clinical Unit of Infectious Diseases, Hospital Universitario de Valme, 3Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, and 4Clinical Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Virgen Macarena, Seville, 5Clinical Unit of Infectious Diseases, Hospital Universita io Reina Sofía, Cordoba, 6Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Virgen de la Victoria, Malaga, and 7Department of Internal Medicine, Hospital Juan Ramón Jiménez, Huelva, Spain

Background.Transient elastometry (TE) is accurate for detecting significant liver fibrosis and cirrhosis in hepatitis C virus (HCV)–monoinfected patients. However, this procedure has been insufficiently validated in patients with human immunodeficiency virus (HIV) and HCV coinfection. The purpose of this study was to validate reported cutoff values of TE that discriminate significant liver fibrosis and cirrhosis in HIV‐HCV–coinfected subjects.

Methods.Liver stiffness measurements were obtained for 169 HIV‐HCV–coinfected adult patients who had undergone a liver biopsy or who had received a nonhistologic diagnosis of cirrhosis within 12 months before or after a liver stiffness measurement. Patients had received no prior therapy for HCV infection.

Results.TE measurements ranged from 3.6 kPa to 75 kPa. The area under the receiver operating characteristic curve was 0.87 (95% confidence interval, 0.84–0.93) for significant liver fibrosis and 0.95 (95% confidence interval, 0.92–0.99) for cirrhosis. To diagnose significant liver fibrosis, a cutoff value of 7.2 kPa was associated with a positive predictive value of 88% and a negative predictive value of 75%. Thirty‐four patients (20%) were misclassified when this cutoff value was used. Thirteen (24%) of 54 patients with liver stiffness values <7.2 kPa had significant liver fibrosis detected by liver biopsy. To diagnose cirrhosis, a cutoff value of 14.6 kPa was associated with a positive predictive value of 86% and a negative predictive value of 94%. Thus, 13 patients (10%) had disease that was misclassified using this cutoff value.

Conclusions.We found that the diagnostic accuracy of TE was high for detecting cirrhosis and good for diagnosis of significant liver fibrosis. However, the performance of TE was low for discriminating mild fibrosis from significant liver fibrosis, which might limit the applicability of this technique in clinical practice.

Received 22 March 2007; accepted 20 June 2007; electronically published 11 September 2007.

Reprints or correspondence: Dr. Juan A. Pineda, Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014 Seville, Spain ().

Cited by

Laurent Castera. (2009) Transient elastography and other noninvasive tests to assess hepatic fibrosis in patients with viral hepatitis. Journal of Viral Hepatitis 16:5, 300-314
Online publication date: 1-Jun-2009.
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S. Moreno, J. García-Samaniego, A. Moreno, E. Ortega, J. A. Pineda, J. del Romero, C. Tural, M. A. von Wichmann, J. Berenguer, Á. Castro, R. Espacio. (2009) Noninvasive diagnosis of liver fibrosis in patients with HIV infection and HCV/HBV co-infection. Journal of Viral Hepatitis 16:4, 249-258
Online publication date: 1-May-2009.
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Gregory D. Kirk, Jacquie Astemborski, Shruti H. Mehta, Chuck Spoler, Cedric Fisher, Danisha Allen, Yvonne Higgins, Richard D. Moore, Nezem Afdhal, Michael Torbenson, Mark Sulkowski, and David L. Thomas. (2009) Assessment of Liver Fibrosis by Transient Elastography in Persons with Hepatitis C Virus Infection or HIV–Hepatitis C Virus Coinfection. Clinical Infectious Diseases 48:7, 963-972
Online publication date: 1-Apr-2009.
Abstract-Full Text-PDF Version (372 kB)
Kentaro Yoshioka, Naoto Kawabe, Senju Hashimoto. (2008) Transient elastography: Applications and limitations. Hepatology Research 38:11, 1063-1068
Online publication date: 1-Dec-2008.
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J. Macias, F. Orihuela, A. Rivero, P. Viciana, M. Marquez, J. Portilla, M. J. Rios, L. Munoz, J. Pasquau, M. A. Castano, L. Abdel-Kader, J. A. Pineda, . (2008) Hepatic safety of tipranavir plus ritonavir (TPV/r)-based antiretroviral combinations: effect of hepatitis virus co-infection and pre-existing fibrosis. Journal of Antimicrobial Chemotherapy 63:1, 178-183
Online publication date: 18-Nov-2008.
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Laurent Castera. (2008) Assessing liver fibrosis. Expert Review of Gastroenterology and Hepatology 2:4, 541-552
Online publication date: 1-Sep-2008.
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