Brief Article
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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
Transient elastography: A non-invasive tool for assessing liver fibrosis in HIV/HCV patients
Valentina Li Vecchi, Maurizio Soresi, Claudia Colomba, Giovanni Mazzola, Pietro Colletti, Maurizio Mineo, Paola Di Carlo, Emanuele La Spada, Giovanni Vizzini, Giuseppe Montalto
Valentina Li Vecchi, Maurizio Soresi, Giovanni Mazzola, Pietro Colletti, Maurizio Mineo, Emanuele La Spada, Giuseppe Montalto, Department of Clinical Medicine and Emerging Pathologies, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
Claudia Colomba, Paola Di Carlo, Infectious Diseases Section, Department of Health Promotion Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
Giovanni Vizzini, Department of Gastroenterology and Hepatology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), University of Pittsburgh Medical Center, Via Tricomi 1, 90127 Palermo, Italy
Author contributions: Montalto G, Li Vecchi V and Mazzola G designed the research; Li Vecchi V, Mazzola G, La Spada E, Colletti P, Mineo M, Colomba C and Di Carlo P performed the research; Soresi M analyzed the data; Li Vecchi V and Montalto G wrote the paper; Montalto G, Soresi M and Vizzini G reviewed the paper.
Correspondence to: Giuseppe Montalto, Professor, Department of Clinical Medicine and Emerging Pathologies, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy.
Telephone: +39-91-6552991 Fax: +39-91-6552977
Received: April 14, 2010
Revised: June 1, 2010
Accepted: June 8, 2010
Published online: November 7, 2010

AIM: To assess the prevalence of advanced liver fibrosis (ALF) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) and HIV/HCV patients using transient elastography, and to identify factors associated with ALF.

METHODS: Between September 2008 and October 2009, 71 HIV mono-infected, 57 HIV/HCV co-infected and 53 HCV mono-infected patients on regular follow-up at our Center were enrolled in this study. Alcohol intake, the main parameters of liver function, presence of HCV-RNA, HIV-RNA, duration of highly active anti-retroviral therapy (HAART) and CD4 cell count were recorded. ALF was defined as liver stiffness (LS) ≥ 9.5 kPa. To estimate liver fibrosis (LF) a further 2 reliable biochemical scores, aspartate aminotransferase platelet ratio index (APRI) and FIB-4, were also used.

RESULTS: LS values of co-infected patients were higher than in either HIV or HCV mono-infected patients (χ2MH = 4, P < 0.04). In fact, LS ≥ 9.5 was significantly higher in co-infected than in HIV and HCV mono-infected patients (χ2 = 5, P < 0.03). Also APRI and the FIB-4 index showed more LF in co-infected than in HIV mono-infected patients (P < 0.0001), but not in HCV mono-infected patients. In HIV⁄HCV co-infected patients, the extent of LS was significantly associated with alcohol intake (P < 0.04) and lower CD4+ cell count (P < 0.02). In HCV patients, LS was correlated with alcohol intake (P < 0.001) and cholesterol levels (P < 0.03). Body mass index, diabetes, HCV- and HIV-viremia were not significantly correlated with LS. In addition, 20% of co-infected patients had virologically unsuccessful HAART; in 50% compliance was low, CD4+ levels were < 400 cells/mm3 and LS was > 9.5 kPa. There was no significant correlation between extent of LF and HAART exposure or duration of HAART exposure, in particular with specific dideoxynucleoside analogues.

CONCLUSION: ALF was more frequent in co-infected than mono-infected patients. This result correlated with lower CD4 levels. Protective immunological effects of HAART on LF progression outweigh its hepatotoxic effects.

Keywords: Liver fibrosis, Transient elastography, Aspartate aminotransferase platelet ratio index, FIB-4 test, Fibrosis evaluation, Human immunodeficiency virus infection, Hepatitis C virus infection