Comparison of the Prognostic Value of Liver Biopsy and FIB-4 Index in Patients Coinfected With HIV and Hepatitis C Virus

Autors de IIS La Fe

• Joaquin Berenguer Lapuerta

  Autor

• Luis Aldamiz-Echevarria Azuara

  Autor

• José López Aldeguer

  Autor

• María Jose Galindo Puerto

  Autor

• Gabriela Alejandra Perez Cataldo

  Autor

Autors aliens a IIS La Fe

• Zamora FX
• Von Wichmann MA
• Crespo M
• Carrero A
• Montes M
• Quereda C
• Téllez MJ
• Sanz J
• Santos I
• Guardiola JM
• Barros C
• Ortega E
• Pulido F
• Rubio R
• Mallolas J
• Tural C
• Jusdado JJ
• Díez C
• Álvarez-Pellicer J
• Esteban H
• Bellón JM
• González-García J
• Grupo de Estudio del SIDA (GESIDA) HIV/HCV Cohort Study Group

Grups d'Investigació

• Hepatología experimental y Trasplante hepático

  Investigador Principal

  Laia Tolosa Pardo

• Investigacion clínica en enfermedades crónicas e Infección por el VIH

  Investigador establecido

  Marta Montero Alonso

Abstract

Background. We compared the prognostic value of liver biopsy (LB) and FIB-4 index in patients with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection. Methods. We studied patients from the Grupo de Estudio del SIDA 3603 study cohort, in whom fibrosis was evaluated at baseline using both LB (Metavir score) and FIB-4 index. We assessed overall death (OD) and liverrelated events (LREs), defined as decompensation or hepatocellular carcinoma, whichever occurred first. We used receiver operating characteristic (ROC) curves to determine the ability of LB and FIB-4 to predict outcomes. We also assessed the association between advanced fibrosis-LB (F3 or greater) or FIB-4 (>= 3.25)-and outcomes using multivariate Cox regression analysis. Results. The study sample comprised 903 patients (328 with sustained virologic response [SVR]). Baseline fibrosis by LB was as follows: F0, n = 71; F1, n = 242; F2, n = 236; F3, n = 236; F4, n = 118. Fibrosis by FIB-4 was as follows: = 1, n = 148; >1 to <3.25, n = 597; = 3.25, n = 158. After a median follow-up of 62 months, there were 46 deaths and 71 LREs. The area under the ROC curves for OD/LREs was 0.648 and 0.742 for LB and FIB-4, respectively (P = .006). Similar results were found for patients without SVR and for OD and LREs separately. The adjusted hazard ratios of OD or LRE were 1.740 (95% confidence interval [CI], 1.119-2.7.06; P = .014) for advanced fibrosis assessed by LB and 3.896 (95% CI, 2.463-6.160; P < .001) assessed by FIB-4. Conclusions. FIB-4 outperformed LB as a predictor of OD and LRE. These findings are of relevance for clinical practice and research and call into question the role of LB as a gold standard for assessing prognosis in HIV/HCV coinfection.

Keywords

• HIV; hepatitis C; interferon; follow-up studies; treatment outcome