Digestive Diseases and Sciences

, Volume 56, Issue 10, pp 3038–3044 | Cite as

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

  • Amy G. Shah
  • Paula G. Smith
  • Richard K. Sterling
Original Article


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.


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.


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.


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.


Non-invasive markers Liver fibrosis HIV–HCV coinfection 



This work was supported by a grant from the National Institute of Health (K23-DK064578) to Richard Sterling and by a grant to the General Clinical Research Center at Virginia Commonwealth University (M01RR00065). This work was presented in part at the American Association for the Study of Liver Diseases Annual Meeting, Boston, MA, USA, November 2008.

Conflict of interest

The authors have no conflicts of interest to disclose. This study was conducted without pharmaceutical support.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Amy G. Shah
    • 1
  • Paula G. Smith
    • 1
  • Richard K. Sterling
    • 1
    • 2
    • 3
  1. 1.Divisions of Gastroenterology, Hepatology and Nutrition Infectious DiseasesVirginia Commonwealth University Health SystemRichmondUSA
  2. 2.Division of Infectious DiseasesVirginia Commonwealth University Health SystemRichmondUSA
  3. 3.Section of HepatologyVirginia Commonwealth University Medical CenterRichmondUSA

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