Proficiency of transient elastography compared to liver biopsy for the assessment of fibrosis in HIV/HBV-coinfected patients

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J Viral Hepat. 2011 Jan;18(1):61-9. doi: 10.1111/j.1365-2893.2010.01275.x.

Proficiency of transient elastography compared to liver biopsy for the

assessment of fibrosis in HIV/HBV-coinfected patients.

Miailhes P, Pradat P, Chevallier M, Lacombe K, Bailly F, Cotte L, Trabaud MA,

Boibieux A, Bottero J, Trepo C, Zoulim F.

Hospices Civils de Lyon, Hôpital Hôtel-Dieu, Service

d'Hépatogastroentérologie, Lyon, France. patrick.miailhes@...

Abstract

Transient elastography (TE) is a noninvasive technique to evaluate liver

fibrosis. We compared the performance of TE with liver biopsy (LB) in patients

with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection.

Patients prospectively underwent TE and LB. The diagnosis accuracy of TE was

calculated using receiver operating characteristic (ROC) curves for different

stages of fibrosis, and optimal cut-off values were defined. A sequential

algorithm combining TE with biochemical score (Fibrotest) is proposed.

Fifty-seven patients had both TE and LB (median time: 3 days) and two with

proven cirrhosis, only TE. Forty-six (78%) were under antiretroviral therapy

with anti-HBV drugs in 98%, and 19 (32%) had elevated alanine aminotransferase

(ALT). A significant correlation was observed between liver stiffness

measurement (LSM) and METAVIR fibrosis stages (P < 0.0001). Patients with

elevated ALT tended to have higher LSM than those with normal ALT. The areas

under the ROC curves were 0.85 for significant fibrosis (≥ F2), 0.92 for

advanced fibrosis (≥ F3) and 0.96 for cirrhosis. Using a cut-off of 5.9 kPa

for F ≥ 2 and 7.6 kPa for F ≥ 3, the diagnosis accuracy was 83% and 86%,

respectively. With an algorithm combining TE and Fibrotest, 97% of patients were

well classified for significant fibrosis. Using this algorithm, the need for LB

can be reduced by 67%. In HIV/HBV-coinfected patients, most of them with normal

ALT under antiretroviral treatment including HBV active drugs, TE was proficient

in discriminating moderate to severe fibrosis from minimal liver disease.

© 2010 Blackwell Publishing Ltd.

PMID: 20196798 [PubMed - indexed for MEDLINE]