Author information
1
Department of Surgery and Cancer, liver unit, St Mary's hospital, Imperial College London, UK.
2
INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France.
3
Service des Maladies Infectieuses , CHU Saint-Pierre, Université Libre de Bruxelles , Brussels , Belgium.
4
Saint-Antoine Hospital, Department of Infectious disease and tropical medicine, University Paris 6, France.
5
Pitie-Salpetriere Hospital, Department of Infectious disease and tropical medicine, University Paris 6, France.
6
Infectious Disease Unit University Medical Center, Hamburg-Eppendorf Germany.
7
AP-HP, Hôpital Tenon, UF Bio-marqueurs Inflammatoires et métaboliques, Service de Biochimie, F-75020, Paris.
8
Sorbonne Université, Faculté de Médecine, F-75012 Paris.
9
Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
10
Center for HIV and Hepatogastroenterology, Düsseldorf, Germany.
11
Saint-Antoine Hospital, Department of Hepatology, University Paris 6, France.
12
Pitie-Salpetriere Hospital, Department of Hepatology University Paris 6, France.
13
Saint-Antoine Hospital , Department of Radiology, University Paris 6, France.
14
Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.
15
Institute of Pathology, Hannover Medical School, Hannover, Germany.
16
Beaujon Hospital, Department of Histopathology, Clichy, France.
17
Center for Infectiology (CIB), Berlin, Germany.
Abstract
BACKGROUND:
HIV-monoinfected individuals are at high risk of non-alcoholic fatty liver disease (NAFLD). Non-invasive tests of steatosis, nonalcoholic steatohepatitis (NASH) and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: MRI proton-density-fat-fraction (MRI-PDFF), Fibroscan®/CAP and biochemical tests.
METHODS:
We enrolled ART-controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, Fibroscan®/CAP, Fibrotest/Nashtest/Steatotest, APRI, FIB-4 and NFS. A LB was indicated if suspected significant fibrosis (Fibroscan≥7.1 kPa and/or Fibrotest≥0.49). Performance was considered as good if area under a ROC curve (AUROC) was >0.80.
RESULTS:
Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age 54 years (53-65), BMI: 26 kg/m (24-30), steatosis in 37 (76%), NASH in 23 (47%) and fibrosis in 31 (63%) patients [F2:7(14%); F3:6(12%); F4:2(4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROC at 0.98 (95%CI:0.96-1.00) and 0.88 (0.76-0.99) respectively, whilst the AUROC of Steatotest was 0.68 (0.51-0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROC at 0.86 (0.74-0.98) and 0.81 (0.67-0.95). In contrast, Fibroscan® and Fibrotest® had poor AUROC (0.61 (0.43-0.79) and 0.61 (0.44-0.78), with very low specificity. Regarding NASH, ALT≥36IU/l had good performance with AUROC of 0.83 (0.71-0.94) while NASHtest had an AUROC of 0.60 (0.44-0.76).
CONCLUSION:
In HIV-monoinfected patients, MRI-PDFF and Fibroscan®/CAP are highly accurate for the diagnosis of steatosis. ALT level and APRI should be considered for the detection of NASH and fibrosis.