Veeral H Ajmera1,2, Edward R Cachay3, Christian B Ramers4, Shirin Bassirian1, Seema Singh1, Richele Bettencourt1, Lisa Richards1, Gavin Hamilton5, Michael Middleton5, Katie Fowler5, Claude Sirlin5, Rohit Loomba1,2,6. 1. NAFLD Research Center, Department of Medicine, University of California, San Diego, La Jolla, California, USA. 2. Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California, USA. 3. Division of Infectious Diseases, Owen Clinic, University of California San Diego, San Diego, California, USA. 4. Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, California, USA. 5. Liver Imaging Group, University of California, San Diego, La Jolla, California, USA. 6. Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
Abstract
BACKGROUND: Controlled attenuation parameter (CAP) is an ultrasound-based point-of-care method to quantify liver fat; however, the optimal threshold for CAP to detect pathologic liver fat among persons living with human immunodeficiency virus (HIV; PLWH) is unknown. Therefore, we aimed to identify the diagnostic accuracy and optimal threshold of CAP for the detection of liver-fat among PLWH with magnetic resonance imaging proton-density fat fraction (MRI-PDFF) as the reference standard. METHODS: Patients from a prospective single-center cohort of PLWH at risk for HIV-associated nonalcoholic fatty liver disease (NAFLD) who underwent contemporaneous MRI-PDFF and CAP assessment were included. Subjects with other forms of liver disease including viral hepatitis and excessive alcohol intake were excluded. Receiver operatic characteristic (ROC) curve analysis were performed to identify the optimal threshold for the detection of HIV-associated NAFLD (liver fat ≥ 5%). RESULTS: Seventy PLWH (90% men) at risk for NAFLD were included. The mean (± standard deviation) age and body mass index were 48.6 (±10.2) years and 30 (± 5.3) kg/m2, respectively. The prevalence of HIV-associated NAFLD (MRI-PDFF ≥ 5%) was 80%. The M and XL probes were used for 56% and 44% of patients, respectively. The area under the ROC curve of CAP for the detection of MRI-PDFF ≥ 5% was 0.82 (0.69-0.95) at the cut-point of 285 dB/m. The positive predictive value of CAP ≥ 285 dB/m was 93.2% in this cohort with sensitivity of 73% and specificity of 78.6%. CONCLUSIONS: The optimal cut-point of CAP to correctly identify HIV-associated NAFLD was 285 dB/m, is similar to previously published cut-point for primary NAFLD and may be incorporated into routine care to identify patients at risk of HIV-associated NAFLD.
BACKGROUND: Controlled attenuation parameter (CAP) is an ultrasound-based point-of-care method to quantify liver fat; however, the optimal threshold for CAP to detect pathologic liver fat among persons living with human immunodeficiency virus (HIV; PLWH) is unknown. Therefore, we aimed to identify the diagnostic accuracy and optimal threshold of CAP for the detection of liver-fat among PLWH with magnetic resonance imaging proton-density fat fraction (MRI-PDFF) as the reference standard. METHODS:Patients from a prospective single-center cohort of PLWH at risk for HIV-associated nonalcoholic fatty liver disease (NAFLD) who underwent contemporaneous MRI-PDFF and CAP assessment were included. Subjects with other forms of liver disease including viral hepatitis and excessive alcohol intake were excluded. Receiver operatic characteristic (ROC) curve analysis were performed to identify the optimal threshold for the detection of HIV-associated NAFLD (liver fat ≥ 5%). RESULTS: Seventy PLWH (90% men) at risk for NAFLD were included. The mean (± standard deviation) age and body mass index were 48.6 (±10.2) years and 30 (± 5.3) kg/m2, respectively. The prevalence of HIV-associated NAFLD (MRI-PDFF ≥ 5%) was 80%. The M and XL probes were used for 56% and 44% of patients, respectively. The area under the ROC curve of CAP for the detection of MRI-PDFF ≥ 5% was 0.82 (0.69-0.95) at the cut-point of 285 dB/m. The positive predictive value of CAP ≥ 285 dB/m was 93.2% in this cohort with sensitivity of 73% and specificity of 78.6%. CONCLUSIONS: The optimal cut-point of CAP to correctly identify HIV-associated NAFLD was 285 dB/m, is similar to previously published cut-point for primary NAFLD and may be incorporated into routine care to identify patients at risk of HIV-associated NAFLD.
Authors: An Tang; Justin Tan; Mark Sun; Gavin Hamilton; Mark Bydder; Tanya Wolfson; Anthony C Gamst; Michael Middleton; Elizabeth M Brunt; Rohit Loomba; Joel E Lavine; Jeffrey B Schwimmer; Claude B Sirlin Journal: Radiology Date: 2013-02-04 Impact factor: 11.105
Authors: An Tang; Ajinkya Desai; Gavin Hamilton; Tanya Wolfson; Anthony Gamst; Jessica Lam; Lisa Clark; Jonathan Hooker; Tanya Chavez; Brandon D Ang; Michael S Middleton; Michael Peterson; Rohit Loomba; Claude B Sirlin Journal: Radiology Date: 2014-09-22 Impact factor: 11.105
Authors: Juan Macías; María Mancebo; Dolores Merino; Francisco Téllez; M Luisa Montes-Ramírez; Federico Pulido; Antonio Rivero-Juárez; Miguel Raffo; Montserrat Pérez-Pérez; Nicolás Merchante; Manuel Cotarelo; Juan A Pineda Journal: Clin Infect Dis Date: 2017-09-15 Impact factor: 9.079