Assessment of liver disease in patients with chronic hepatitis C and unhealthy alcohol use

Table 1 Studies that have used transient elastography in patients with alcohol-related liver disease

Ref.	Number of patients	Advanced liver fibrosis (≥ 3)	Sensitivity1	Specificity1
Nguyen-Khac et al[58], 2018	103	51%	87%	80%
Nahon et al[59], 2008	147	75%	87%	89%
Kim et al[107], 2009	45	80%	97%	78%
Mueller et al[57], 2010	101	45%	91%	75%
Janssens et al[60], 2010	49	65%	72%	76%
Fernandez et al[61], 2015	135	53%	91%	68%

¹Sensitivity and specificity are calculated using liver biopsy as the gold standard.

Table 2 Studies that used non-patented indices to estimate liver fibrosis in patients with hepatitis C virus infection and unhealthy alcohol use

Ref.	Setting	Non-invasive method	Method for detecting alcohol consumption	Finding
Lieber et al[87], 2006	Veterans' affairs studies (2) of alcoholic liver disease	APRI1	Average alcohol intake	Low sensitivity and specificity of APRI in comparison to liver biopsy, especially in patients with HCV
Chaudhry et al[89], 2009	HIV Hopkins clinical cohort	APRI1	Past 6 mo of hazardous drinking	No effect of alcohol on APRI values in HCV/HIV co-infection
Blackard et al[90], 2011	WIHS cohort	FIB-42	Recent drinking	No association between alcohol intake and FIB-4 values in HCV/HIV co-infection
Muga et al[92], 2012	Patients with AUD admitted for detoxification	FIB-42	Past 6 mo of unhealthy drinking	No association between FIB-4 and alcohol use in HCV/HIV co-infection
Fuster et al[93], 2013	HIV-LIVE cohort	FIB-42 and APRI1	LDH	No association between LDH and liver fibrosis measured with FIB-4 or APRI
Lim et al[94], 2014	VACS cohort	FIB-42	AUDIT-C3	Advanced liver fibrosis correlated with alcohol use
Kelly et al[91], 2017	WIHS cohort	FIB-42	Average number of drinks per week, past 6 mo	Light/moderate drinking was not associated with accelerated fibrosis progression
Sanvisens et al[25], 2018	Patients with AUD admitted for detoxification	FIB-42; APRI1; Forns	Past 6 mo, daily alcohol intake	Patients with HCV were two times as likely to present with advanced liver fibrosis

¹Aspartate aminotransferase (AST)/platelet ratio index: AST to platelet ratio index = {[Patient AST/AST upper limit of normal (IU/L)]/platelet count (10⁹/L)} × 100.

²FIB-4 = Age × AST (IU/L)/platelet count (10⁹/L) × alanine aminotransferase (IU/L)^1/2.

³AUDIT-C: Alcohol use disorders identification test. HCV: Hepatitis C virus; AST: Aspartate aminotransferase; APRI: AST/platelet ratio index; FIB-4: Fibrosis-4; AUD: Alcohol use disorder; HIV: Human immunodeficiency virus; LDH: Lifetime drinking History; WIHS: Women's interagency HIV study; VACS: Veterans aging cohort study.