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Diagnostic value of serological biomarkers for detection of non‐alcoholic fatty liver disease (NAFLD) and/or advanced liver fibrosis in people living with HIV
Author(s) -
Yanavich C,
Pacheco AG,
Cardoso SW,
Nunes EP,
Chaves USB,
Freitas G,
Santos R,
Morata M,
Veloso VG,
Grinsztejn B,
Perazzo H
Publication year - 2021
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.13060
Subject(s) - medicine , fatty liver , transient elastography , gastroenterology , fibrosis , interquartile range , body mass index , steatosis , nonalcoholic fatty liver disease , pathology , liver fibrosis , disease
Objectives We aimed to evaluate the accuracy of serological biomarkers for non‐alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR‐F3F4) in HIV mono‐infected individuals. Methods In all, 674 participants from the PROSPEC‐HIV study (NCT02542020), who had blood sample tests and transient elastography (TE) performed on the same day, were eligible. Exclusion criteria were viral hepatitis co‐infection ( n = 90), abusive alcohol intake ( n = 61), missing data ( n = 47) or unreliable TE ( n = 39). NAFLD was defined by controlled attenuation parameter ≥ 248 dB/m and advanced fibrosis by liver stiffness measurement ≥ 8.7 kPa with M probe or ≥ 7.2 kPa with XL probe. Biomarkers for NAFLD [Steato‐ELSA, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), NAFLD‐Liver Fat Score (NAFLD‐LFS)] and fibrosis [Fibrosis‐4 score (FIB‐4), Aspartate‐to‐Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS)] were calculated. Results A total of 437 patients [57% female, age = 44 (interquartile range: 35–52) years, body mass index (BMI) = 26.1 (23.4–29.3) kg/m 2 , CD4 = 660 (427–901) cells/μL] were included. The prevalence [95% confidence interval (CI)] of NAFLD and advanced fibrosis were 38.2% (33.8–42.9) and 10.5% (8.0–13.8), respectively. The areas (95% CI) under the receiver operator curve (AUROCs) for diagnosis of NAFLD were 0.854 (0.818–0.889), 0.840 (0.804–0.877), 0.805 (0.762–0.847) and 0.793 (0.750–0.836) for Steato‐ELSA, FLI, HSI and NAFLD‐LFS ( P < 0.001), respectively. All tests yielded satisfactory sensitivities, specificities and negative predictive values (NPVs). The AUROCs (95% CI) for diagnosis of advanced fibrosis were 0.736 (0.659–0.814), 0.700 (0.614–0.7851) and 0.795 (0.726–0.864) for FIB‐4, APRI and NFS ( P = 0.077), respectively. These tests yielded high specificities and negative predictive values (NPVs) > 90%. Conclusion Biomarkers for NAFLD had a good accuracy and those for fibrosis had high specificities and NPVs. These tests should be integrated to HIV care to detect NAFLD and to exclude advanced liver fibrosis.