Maud Lemoine1, Lambert Assoumou2, Stephane De Wit3, Pierre-Marie Girard4, Marc Antoine Valantin5, Christine Katlama5, Coca Necsoi3, Pauline Campa4, Anja D Huefner6, Julian Schulze Zur Wiesch6, Hayette Rougier4, Jean-Philippe Bastard7,8, Hartmut Stocker9, Stefan Mauss10, Lawrence Serfaty11, Vlad Ratziu12, Yves Menu13, Jerome Schlue14, Georg Behrens15, Pierre Bedossa16, Jacqueline Capeau7,8, Patrick Ingiliz17, Dominique Costagliola2. 1. Liver Unit, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom. 2. Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Paris, France. 3. Department of Infectious Diseases and Tropical Medicine, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Infectious disease and Tropical Medicine, Saint-Antoine Hospital, University Paris 6, Paris, France. 5. Department of Infectious disease and Tropical Medicine, Pitie-Salpetriere Hospital, University Paris 6, Paris, France. 6. Infectious Disease Unit, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany. 7. Service de Biochimie, UF Bio-marqueurs Inflammatoires et Métaboliques, AP-HP, Hôpital Tenon, Paris, France. 8. INSERM, CRSA, UMR_S 938, Faculté de Médecine, Sorbonne Université, Paris, France. 9. Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany. 10. Center for HIV and Hepatogastroenterology, Düsseldorf, Germany. 11. Department of Hepato-Gastroenterology, Hautepierre Hospital, Hôpitaux Universitaires de Strasbourg, INSERM UMR-S938, Paris Sorbonne University, Paris, France. 12. Department of Hepatology, Pitie-Salpetriere Hospital, University Paris 6, Paris, France. 13. Department of Radiology, Saint-Antoine Hospital, University Paris 6, Paris, France. 14. Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany. 15. Institute of Pathology, Hannover Medical School, Hannover, Germany. 16. Department of Histopathology, Beaujon Hospital, Clichy, France. 17. Center for Infectiology (CIB), Berlin, Germany.
Abstract
BACKGROUND: HIV-monoinfected individuals are at high risk of nonalcoholic fatty liver disease. Noninvasive tests of steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), FibroScan/controlled attenuation parameter (CAP), and biochemical tests. METHODS: We enrolled antiretroviral therapy-controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, FibroScan/CAP, FibroTest/NashTest/SteatoTest, APRI, FIB-4, and nonalcoholic fatty liver disease-fibrosis score. A LB was indicated if suspected significant fibrosis (FibroScan ≥7.1 kPa and/or FibroTest ≥0.49). Performance was considered as good if area under a receiver operating characteristic curves (AUROCs) was >0.80. RESULTS: Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age of 54 years (53-65), body mass index: 26 kg/m (24-30), steatosis in 37 (76%), NASH in 23 (47%), and fibrosis in 31 (63%) patients [F2: 7 (14%); F3: 6 (12%); and F4: 2 (4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROCs at 0.98 (95% confidence interval: 0.96 to 1.00) and 0.88 (0.76 to 0.99), respectively, whereas the AUROCs of SteatoTest was 0.68 (0.51 to 0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROCs at 0.86 (0.74 to 0.98) and 0.81 (0.67 to 0.95). By contrast, FibroScan and FibroTest had poor AUROCs [0.61 (0.43 to 0.79) and 0.61 (0.44 to 0.78)], with very low specificity. Regarding NASH, alanine aminotransferase ≥36 IU/L had good performance with AUROCs of 0.83 (0.71 to 0.94), whereas the NashTest had an AUROC of 0.60 (0.44 to 0.76). CONCLUSIONS: In HIV-monoinfected patients, MRI-PDFF and FibroScan/CAP are highly accurate for the diagnosis of steatosis. The alanine aminotransferase level and APRI should be considered for the detection of NASH and fibrosis.
BACKGROUND:HIV-monoinfected individuals are at high risk of nonalcoholic fatty liver disease. Noninvasive tests of steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), FibroScan/controlled attenuation parameter (CAP), and biochemical tests. METHODS: We enrolled antiretroviral therapy-controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, FibroScan/CAP, FibroTest/NashTest/SteatoTest, APRI, FIB-4, and nonalcoholic fatty liver disease-fibrosis score. A LB was indicated if suspected significant fibrosis (FibroScan ≥7.1 kPa and/or FibroTest ≥0.49). Performance was considered as good if area under a receiver operating characteristic curves (AUROCs) was >0.80. RESULTS: Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age of 54 years (53-65), body mass index: 26 kg/m (24-30), steatosis in 37 (76%), NASH in 23 (47%), and fibrosis in 31 (63%) patients [F2: 7 (14%); F3: 6 (12%); and F4: 2 (4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROCs at 0.98 (95% confidence interval: 0.96 to 1.00) and 0.88 (0.76 to 0.99), respectively, whereas the AUROCs of SteatoTest was 0.68 (0.51 to 0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROCs at 0.86 (0.74 to 0.98) and 0.81 (0.67 to 0.95). By contrast, FibroScan and FibroTest had poor AUROCs [0.61 (0.43 to 0.79) and 0.61 (0.44 to 0.78)], with very low specificity. Regarding NASH, alanine aminotransferase ≥36 IU/L had good performance with AUROCs of 0.83 (0.71 to 0.94), whereas the NashTest had an AUROC of 0.60 (0.44 to 0.76). CONCLUSIONS: In HIV-monoinfectedpatients, MRI-PDFF and FibroScan/CAP are highly accurate for the diagnosis of steatosis. The alanine aminotransferase level and APRI should be considered for the detection of NASH and fibrosis.
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