25 Ago HIGH RATE OF MISCLASSIFICATION OF SIGNIFICANT FIBROSIS AND CIRRHOSIS USING APRI AND FIB-4 IN HIV/HCV CO-INFECTED AND HCV MONO-INFECTED PATIENTS

AIM. To assess and compare the diagnostic reliability for the staging of liver fibrosis of two indirect biomarkers, APRI and FIB-4, using transient elastography (TE) as reference standard, among HIV/HCV and HCV monoinfected patients.
MATERIALS&METHODS. This is an observational, retrospective study. All patients underwent blood tests and TE within one month to determine liver stiffness measurement. Diagnostic accuracy and optimal cut-off values of indirect biomarkers for TE ≥ 7.1kPa (significant fibrosis) and TE ≥ 12 kPa (cirrhosis) were determined by ROC curves. In the cohort of HIV/HCV patients, we also studied the performance after stratifying for BMI < or ≥ 25, ALT < or ≥ 40 IU/L, ALT < or ≥ 80 IU/L, and presence/absence of hepatic steatosis
RESULTS. The study included 238 HIV/HCV coinfected and 1937 HCV monoinfected patients. Performances of Fib4 and APRI for the detection of TE ≥ 7.1kPa and TE ≥ 12kPa among the two cohorts proved to be unsatisfactory, with unexpected very high rate of false negative/false positive rates. No significant difference in the performance of the two tests among the two cohorts was found. No significant differences were found after stratification of HIV/HCV coinfected patients in the subgroups
CONCLUSIONS. Differently to other studies, we detected the unreliability of APRI and Fib4 and their inapplicability in clinical practice for the assessment of liver fibrosis both in coinfected and in monoinfected patients.