Comparison of FIB-4 and APRI in HIV-HCV Coinfected Patients with Normal and Elevated ALT

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Dig Dis Sci. 2011 Apr 28. [Epub ahead of print]

Comparison of FIB-4 and APRI in HIV-HCV Coinfected Patients with Normal and

Elevated ALT.

Shah AG, PG, Sterling RK.

Source

Divisions of Gastroenterology, Hepatology and Nutrition Infectious Diseases,

Virginia Commonwealth University Health System, Richmond, VA, USA.

Abstract

BACKGROUND AND AIMS:

Liver biopsy is standard for assessment of disease severity in patients with

chronic HCV. However, associated risks have led to the development of simple

non-invasive models. However, their utility in those with normal ALT is unknown.

METHODS:

FIB-4 and APRI were calculated for patients with HIV-HCV coinfection undergoing

biopsy. The performance of each model and AUROC for predicting significant

fibrosis (Ishak 4-6) were determined for the entire cohort and stratified by

elevated (™60 U/l in men and ™40 U/l in women) and normal ALT.

RESULTS:

Two-hundred and ninety-five liver biopsies from 237 patients were included.

Elevated ALT was observed in 55, and 15% had significant fibrosis. The AUROC

curve for patients with elevated ALT was 0.8 for FIB-4 and 0.76 for APRI,

compared with 0.90 for the FIB-4 and 0.85-0.95 for the APRI in those with normal

ALT. The sensitivity, specificity, positive predictive value (PPV), and negative

predictive value (NPV) of FIB-4 were 1.0, 0.91, 0.50, and 1.0 for patients with

normal ALT; the values were 0.67, 0.99, 0.67, and 0.99 for APRI.

CONCLUSIONS:

Both FIB-4 and APRI are useful for highly accurate identification of those

without advanced fibrosis. However, because they have poor positive predictive

value, liver biopsy will continue to be used for assessment of patients with

coinfection.

PMID: 21526398 [PubMed - as supplied by publisher]