Transient elastography: A non-invasive tool for assessing liver fibrosis in HIV/HCV patients

doi:10.3748/wjg.v16.i41.5225

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Nov 7, 2010 (publication date) through Mar 6, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Nov 7, 2010; 16(41): 5225-5232
Published online Nov 7, 2010. doi: 10.3748/wjg.v16.i41.5225

Table 1 Demographic characteristics of the study populations (mean ± SD) n (%)

	HIV (n = 71)	HCV (n = 53)	HIV/HCV (n = 66)
Age (yr)	43.3 ± 10.3^a	49.7 ± 12.5	45.6 ± 12.5
Male gender	50 (70)	36 (67.9)	49 (74.2)
BMI (kg/m²)	23.6 ± 3.4^a	26.0 ± 3.6	22.8 ± 3.0^b
Risk group
Transfusion	-	17 (32.1)	4 (6.1)^b
Homosexual men	21 (29.5)	-	1 (1.5)
Intravenous drug use	4 (5.6)	7 (13.2)^c	41 (62.1)
Others	-	12 (22.6)	-
Unknown	9 (12.6)	16 (30.2)	8 (12.1)
HCV genotype 3:non3	-	7:46^d	20:46
HAART	57 (80.2)	-	60 (90.9)
Alcohol	6 (8.4)	4 (7.5)	5 (7.5)
Diabetes + IFG	2 (2.8)	4 (7.5)^e	11 (16.6)

^aP < 0.002,

^bP < 0.0001 vs hepatitis C virus (HCV);

^cP < 0.0001,

^dP < 0.03,

^eP < 0.001 vs human immunodeficiency virus (HIV)/HCV. IFG: Impaired fasting glucose; BMI: Body mass index; HAART: Highly active anti-retroviral therapy.

Table 2 Main hematological and virological parameters in the three study groups (mean ± SD)

	HIV (n = 71)	HCV (n = 53)	HIV/HCV (n = 66)
AST/ALT	1 ± 0.4	0.72 ± 0.28^a^j	0.9 ± 0.4
ALT (U/L), mean (range)	22 (7-113)^f^h	75 (16-551)	56.5 (9-280)^g
AST (U/L), mean (range)	21 (11-56)^f^h	52.5 (18-209)	42.5 (14-281)
γGT (IU/L), mean (range)	33 (9-461)^h	40.5 (10-479)ⁱ	76.5 (11-479)
Mean platelet count (10⁹/L)	208 ± 59	184 ± 60	173 ± 61^b
T-Chol (mg/dL)	201 ± 46	175 ± 28^d	171 ± 48^c
HDL-Chol (mg/dL)	44 ± 16	47 ± 12	44 ± 15
LDL Chol (mg/dL)	123 ± 32	108 ± 37.5	97 ± 40^a
TG (mg/dL), mean (range)	137 (36-615)	103 (32-354)^e^j	118 (49-614)
HCV-RNA (IU/mL) > 700.000	-	29 (54.7)	44 (66.6)
HIV-RNA (copies/mL), mean (range)	6050 (50-700 000)	-	3300 (60-1 100 000)
HIV-RNA < 47 copies/mL (%)	44 (62)		45 (68.1)
CD4+ count (cells/μL), mean (range)	466.5 (17-1282)	-	446 (35-1445)
CD4+ < 200 cells/μL	38¹	-	38²

^aP < 0.0001,

^bP < 0.002,

^cP < 0.001,

^dP < 0.004,

^eP < 0.02 vs human immunodeficiency virus (HIV);

^fP < 0.0001,

^gP < 0.02 vs hepatitis C virus (HCV);

^hP < 0.0001,

ⁱP < 0.01,

^jP < 0.05 vs HIV/HCV.

¹Data available in 66 patients;

²Data available in 56 patients. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; γGT: γ-glutamyl transferase; T-Chol: Total cholesterol; HDL: High density lipoprotein; LDL: Low density lipoprotein; TG: Triglyceride.

Table 3 Estimates of liver fibrosis using transient elastography in the study population n (%)

LS	Metavir	HIV (n = 71)	HCV (n = 53)	HIV/HCV (n = 57)
< 7.1	F0-F1	56 (78.8)	23 (43.4)	19 (33.3)
7.1-9.4	F2	11 (15.4)	15 (28.3)	9 (15.8)
9.5-12.4	F3	1 (1.4)	4 (7.5)	9 (15.8)
≥ 12.5	F4	3 (4.2)	11 (20.7)	20 (35.1)	χ²_MH = 4, P < 0.04
≥ F3		4 (5.6)	15 (28.3)	29 (50.9)	χ² = 5, P < 0.03

HIV: Human immunodeficiency virus; HCV: Hepatitis C virus; LS: Liver stiffness.

Table 4 Estimates of liver fibrosis using biochemical markers and transient elastography, mean (range)

	HIV (n = 71)	HCV (n = 53)	HIV/HCV (n = 57)
APRI	0.31 (0.1-1.6)^a^b	0.93 (0.28-6.07)	0.92 (0.17-19.7)
FIB-4	0.93 (0.39-4.28)^a	1.62 (0.47-12.6)	1.63 (0.63-23.8)
LS	5.4 (3.2-26.6)^a^b	7.3 (3.4-40.9)^c	9.8 (4.3-48.8)

^aP < 0.0001 vs hepatitis C virus (HCV);

^bP < 0.0001,

^cP < 0.05 vs human immunodeficiency virus (HIV)/HCV. LS: Liver stiffness; APRI: Aspartate aminotransferase platelet ratio index.

Table 5 Correlation between liver stiffness and aminotransferase platelet ratio index/FIB-4 values according to the liver stiffness cut-offs

	LS < 7.1 kPa (n = 98)		LS (7.1-9.4 kPa) (n = 35)		LS≥9.5 kPa (n = 48)
	r	P	r	P	r	P
APRI	0.01	NS	0.23	NS	0.50	< 0.0001
FIB-4	0.01	NS	0.25	NS	0.53	< 0.0001

APRI: Aminotransferase platelet ratio index; LS: Liver stiffness; NS: Not significant.

Table 6 Correlation (r or ρ) between liver stiffness and studied parameters

	LS
	HIV	HCV	HIV/HCV
BMI	0.11	-0.1	0.02
HCV genotype 3/non 3	-	-0.1	-0.26
HCV-RNA	-	-	-0.26
HIV-RNA	0.21	-	0.18
Time HAART	-0.047	-	0.09
CD4 cells count	0.074	-	-0.32^d
Alcohol	-0.096	0.70^a	0.30^e
T-Chol	-0.09	-0.32^b	-0.18
TG	0.06	0.18	0.1
HDL-Chol	-0.1	0.05	-0.16
Diabetes + IFG	-0.01	0.19	0.14
Time HCV	-	0.24	-0.02
ALT	0.03	0.1	0.23
AST	0.18	0.56^c	0.40^a
Platelets	-0.02	-0.56^c	-0.61^c
APRI score	0.04	0.70^c	0.50^c
FIB-4 score	0.06	0.75^c	0.60^c

LS: Liver stiffness; HIV: Human immunodeficiency virus; HCV: Hepatitis C virus; BMI: Body mass index; HAART: Highly active anti-retroviral therapy; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; T-Chol: Total cholesterol; HDL: High density lipoprotein; TG: Triglyceride; IFG: Impaired fasting glucose; APRI: Aminotransferase platelet ratio index.

^aP < 0.001;

^bP < 0.03;

^cP < 0.0001;

^dP < 0.02;

^eP < 0.04.

Citation: Li Vecchi V, Soresi M, Colomba C, Mazzola G, Colletti P, Mineo M, Di Carlo P, La Spada E, Vizzini G, Montalto G. Transient elastography: A non-invasive tool for assessing liver fibrosis in HIV/HCV patients. World J Gastroenterol 2010; 16(41): 5225-5232
URL: https://www.wjgnet.com/1007-9327/full/v16/i41/5225.htm
DOI: https://dx.doi.org/10.3748/wjg.v16.i41.5225