Efficiency of transient elastography in diagnosis of liver fibrosis in patients with HIV/HCV co-infection

Objective To investigate the efficiency of transient elastography(TE) in the diagnosis of liver fibrosis in patients with human immunodeficiency virus(HIV)/hepatitis C virus(HCV) co-infection.Methods The patients with HIV/HCV co-infection who were hospitalized in The Sixth People's Hospital of Xinjiang Uygur Autonomous Region from January 2013 to December 2018 were enrolled and related indices were collected,including routine blood test results,liver function,renal function,coagulation,biochemical parameters for liver fibrosis,and viral load of HIV and HCV.Noninvasive models for liver fibrosis [aspartate aminotransferase-to-platelet ratio index(APRI) and fibrosis-4(FIB-4) ]were calculated,and liver biopsy was performed for all patients.TE was performed within 3 days before biopsy,and the results were expressed as liver stiffness measurement(LSM).A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison between multiple groups;a Spearman correlation analysis was used to investigate the correlation of LSM,APRI,FIB-4,biochemical parameters for liver fibrosis,HCV RNA quantification,and liver biopsy results with the stage of liver fibrosis;the receiver operating characteristic(ROC) curve was used to evaluate the efficiency and cut-off value of LSM in determining the stage of liver fibrosis.Results A total of 76 patients with chronic HCV/HIV co-infection who underwent liver biopsy and were diagnosed with liver fibrosis were enrolled.The correlation analysis showed that LSM had the best correlation with the stage of liver fibrosis(r=0.526,P<0.001)and had a better correlation than APRI(r=0.403,P<0.001) and FIB-4(r=0.441,P<0.001),and among the biochemical parameters for liver fibrosis,only type IV collagen was correlated with the stage of liver fibrosis(r=0.339,P<0.05).HCV RNA quantification had no correlation with the stage of liver fibrosis.For marked liver fibrosis,LSM had an area under the ROC curve of 0.809,0.929,and0.906,respectively,in the diagnosis of S2,S3,and S4 liver fibrosis at the optimal cut-off values of 11.6 k Pa,12.7 k Pa,and 14.5 k Pa,respectively.Conclusion TE can accurately determine the stage of liver fibrosis in patients with HCV/HIV co-infection,which might help to avoid liver biopsy and provide a more reliable basis for developing antiviral regimen and judging the progression of liver fibrosis,and therefore,it holds promise for clinical application.