Assessment of Liver Fibrosis by Non-invasive Techniques 

By Marina Nunez, PhD, MD

There is growing interest for the assessment of liver fibrosis using non-invasive techniques in HIV-infected patients. Several studies evaluating liver damage in the context of HIV/hepatitis-coinfection presented at the recent 13^th CROI were based on serum markers or transient elastography (FibroScan).

Significant fibrosis evaluated by serum markers was found in HIV-infected patients with chronic viral hepatitis, particularly among those tri-infected with HIV, HBV and HCV, consistent with estimates derived from liver biopsy cohorts according to an US study already commented on in HIV and Hepatitis.com [1,2].

In two separate studies, Spanish investigators assessed liver fibrosis using transient elastography (FibroScan®) in HIV/HCV-coinfected patients [3,4]. In the first work, 112 patients who had previously received interferon-based therapy were evaluated.

Sustained virological response (SVR) had been achieved by 44 of them, while the remaining 68 were non-responders or relapsers. Fibrosis scores as measured by elastography are shown in table 1. Significantly less patients in the SVR group had F3-F4 scores compared to the non-SVR group (14% versus 24%; p=0.04).

Table 1. Liver fibrosis as measured by elastography according to response to therapy.

In the second study, predictors of liver fibrosis (assessed also by FibroScan®) were searched in 283 HIV/HCV-coinfected patients [4]. In 164 of them (58%), fibrosis scores indicated advanced liver fibrosis (F2–F4), as determined using transient elastometry.

In multivariate analysis, HCV genotype 3 [OR 4.3 (95% CI, 1.4–13.3); p=0.01]), older age [OR 1.1 (95% CI, 1.01–1.25); p=0.03] and elevated alanine aminotransferase levels [OR 1.03 (95% CI, 1.01–1.04); p=0.001] were associated with F2-F4 scores.

In the discussion of these results, the researchers speculated that the known association between HCV genotype 3 and liver steatosis might explain the more advanced degrees of fibrosis in this subset of patients.

02/28/06

References

1. M Sulkowski and others. Estimated prevalence of significant liver disease among 4052 HIV-infected adults with and without chronic hepatitis B and C. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO [Abstract 842].

2. M Sulkowski and others. Prediction of significant hepatic fibrosis in HIV/HCV-coinfected patients: comparison of the FIB-4, APRI and Johns Hopkins Fibrosis Index. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO [Abstract 867].

3. P Barreiro and others. Sustained virological response following HCV therapy is associated with regression of liver fibrosis in HCV/HIV coinfected patients. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO [Abstract 859].

4. P Barreiro and others. Predictors of liver fibrosis in HIV-infected patients with chronic hepatitis C. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO [Abstract 868].