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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 28, 2015; 7(24): 2510-2521
Published online Oct 28, 2015. doi: 10.4254/wjh.v7.i24.2510
Liver fibrosis in human immunodeficiency virus/hepatitis C virus coinfection: Diagnostic methods and clinical impact
Caterina Sagnelli, Salvatore Martini, Mariantonietta Pisaturo, Giuseppe Pasquale, Margherita Macera, Rosa Zampino, Nicola Coppola, Evangelista Sagnelli
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara, Second University of Naples, 80131 Naples, Italy
Salvatore Martini, Giuseppe Pasquale, Nicola Coppola, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
Mariantonietta Pisaturo, Division of Infectious Diseases, AORN Sant’Anna e San Sebastiano di Caserta, 81100 Caserta, Italy
Margherita Macera, Azienda Ospedaliera Universitaria, Second University of Naples, 80131 Naples, Italy
Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, 80131 Naples, Italy
Author contributions: Sagnelli C, Martini S, Pisaturo M, Pasquale G, Macera M, Zampino R, Coppola N and Sagnelli E made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.
Conflict-of-interest statement: All the authors of the manuscript declare that they have no conflict of interest in connection with this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Evangelista Sagnelli, Professor, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via L. Armanni 5, 80131 Naples, Italy. evangelistasagnelli@libero.it
Telephone: +39-81-5666719 Fax: +39-81-5666207
Received: May 13, 2015
Peer-review started: May 15, 2015
First decision: June 23, 2015
Revised: July 18, 2015
Accepted: September 30, 2015
Article in press: October 9, 2015
Published online: October 28, 2015
Abstract

Several non-invasive surrogate methods have recently challenged the main role of liver biopsy in assessing liver fibrosis in hepatitis C virus (HCV)-monoinfected and human immunodeficiency virus (HIV)/HCV-coinfected patients, applied to avoid the well-known side effects of liver puncture. Serological tests involve the determination of biochemical markers of synthesis or degradation of fibrosis, tests not readily available in clinical practice, or combinations of routine tests used in chronic hepatitis and HIV/HCV coinfection. Several radiologic techniques have also been proposed, some of which commonly used in clinical practice. The studies performed to compare the prognostic value of non-invasive surrogate methods with that of the degree of liver fibrosis assessed on liver tissue have not as yet provided conclusive results. Each surrogate technique has shown some limitations, including the risk of over- or under-estimating the extent of liver fibrosis. The current knowledge on liver fibrosis in HIV/HCV-coinfected patients will be summarized in this review article, which is addressed in particular to physicians involved in this setting in their clinical practice.

Keywords: Human immunodeficiency virus/hepatitis C virus coinfection, Liver fibrosis, Liver biopsy, Fibroscan, Liver ultrasonography

Core tip: The extent of liver fibrosis is a marker of disease progression influencing the clinical and therapeutic decisions to be made for human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. The international guidelines suggest anti-HCV therapy for HIV/HCV-coinfected patients with histological fibrosis score ≥ 2 in the Metavir scoring system since they have an increased risk of liver failure. Due to the high clinical impact of liver fibrosis and of the well-known limitations of liver biopsy, surrogate, non-invasive technologies have been researched. The pros and cons of liver biopsy and surrogate technologies in detecting liver fibrosis in HIV/HCV-coinfected patients will be discussed in this review article.