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Suboptimal performance of APRI and FIB-4 in ruling out significant fibrosis and confirming cirrhosis in HIV/HCV co-infected and HCV mono-infected patients

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Abstract

Purpose

We aimed to assess the diagnostic reliability of two indirect biomarkers, APRI and FIB-4, for the staging of liver fibrosis using transient elastography (TE) as reference standard, among HIV/HCV co-infected and HCV mono-infected patients.

Methods

This is an observational, retrospective study on subjects who had access to the RESIST HCV from October 2013 to December 2016, a regional network encompassing 22 hospitals and academic centers throughout Sicily. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) < 9.5 kPa (significant fibrosis) and LSM ≥ 12.5 kPa (cirrhosis) were determined by receiver operator characteristics (ROC) curves.

Results

238 HIV/HCV co-infected and 1937 HCV mono-infected patients were included. Performances of FIB-4 and APRI for the detection of significant fibrosis and cirrhosis proved to be unsatisfactory, with very high false negative and false positive rates among both cohorts. No significant differences were found after stratification of HIV/HCV co-infected patients for BMI < or ≥ 25, ALT < or ≥ 40 IU/L, ALT < or ≥ 80 IU/L, and presence/absence of a bright liver echo pattern on ultrasonography.

Conclusions

Differently from other studies, we detected the unreliability of APRI and FIB-4 for the assessment of liver fibrosis in both HCV mono-infected and HIV/HCV co-infected patients.

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Authors and Affiliations

  1. Department of Sciences for Health Promotion “G. D’Alessandro”, University of Palermo, Palermo, Italy

    Giovanni Mazzola, Lucia Adamoli, Pietro Colletti, Adriana Cervo, Marcello Trizzino & Antonio Cascio

  2. Di.Bi.M.I.S, Section of Gastroenterology, University of Palermo, Palermo, Italy

    Vincenza Calvaruso & Vito Di Marco

  3. IBD Unit, “Villa Sofia-Cervello” Hospital, Via Trabucco 180, 90146, Palermo, Italy

    Fabio Salvatore Macaluso & Ambrogio Orlando

  4. Clinical Epidemiology and Cancer Registry Unit, A.O.U.P. “Paolo Giaccone”, Palermo, Italy

    Sergio Mazzola

  5. ARNAS “Civico-Benefratelli” Hospital, Palermo, Italy

    Francesco Di Lorenzo, Chiara Iaria & Tullio Prestileo

Authors
  1. Giovanni Mazzola
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  2. Lucia Adamoli
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  3. Vincenza Calvaruso
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  4. Fabio Salvatore Macaluso
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  5. Pietro Colletti
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  6. Sergio Mazzola
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  7. Adriana Cervo
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  8. Marcello Trizzino
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  9. Francesco Di Lorenzo
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  10. Chiara Iaria
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  11. Tullio Prestileo
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  12. Ambrogio Orlando
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  13. Vito Di Marco
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  14. Antonio Cascio
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Corresponding author

Correspondence to Fabio Salvatore Macaluso.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Mazzola, G., Adamoli, L., Calvaruso, V. et al. Suboptimal performance of APRI and FIB-4 in ruling out significant fibrosis and confirming cirrhosis in HIV/HCV co-infected and HCV mono-infected patients. Infection 47, 409–415 (2019). https://doi.org/10.1007/s15010-018-1258-6

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  • DOI: https://doi.org/10.1007/s15010-018-1258-6

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