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Screening for liver fibrosis in HIV-mono-infected patients with increased ALT comparing FibroScan with FIB-4


Elevated ALT values are frequently observed in HIV-mono-infected patients. Recent studies have reported cases of cryptogenic liver cirrhosis in HIV+ individuals. Other possible explanations are non-alcoholic/alcoholic steatohepatitis and drug toxicity. We have used two non-invasive methods, liver elastometry (FibroScan) and a serologic fibrosis index (FIB-4), for liver fibrosis screening in a single centre.


HIV-infected patients without hepatitis B and C co-infection with at least one elevated ALT in 2007/2008 (males >50 U/l, females >35 U/l) were selected for liver elastometry by FibroScan (Echosens, Paris). Antiretroviral medication, co-medication, alcohol consumption, smoking, recreational drug use and BMI were assessed. Liver stiffness was classified as <7.2 kPa (no/minimal fibrosis), 7.2–12.5 kPa (moderate fibrosis), >12.5 -17.6 kPa (severe fibrosis), >17.6 kPa (cirrhosis). FibroScans were performed by two trained and experienced investigators (high inter-observer-correlation, r = 0.80, p < .05). FIB-4 index (age[years] × AST[U/l])/(platelets [10^9/l] × ALT^0.5 [U/l]) was used for serologic fibrosis assessment. For statistical evaluation, SPSS 15.0 was used.

Summary of results

Out of 1,098 HIV-infected individuals, 227 had increased ALT without hepatitis co-infection; 81 patients were consecutively screened by FibroScan. A valid elastometry was obtained in 79/81 (98%) patients. 76/81 were male, median age was 45 years (27–71 years), median BMI 24.6 kg/sqm (19.1–33.7 kg/sqm), median ALT 60 U/l (38–144 U/l). 70/81 (86%) were on antiretroviral therapy with median duration of 76 months. HIV-RNA was <40 copies/ml in 63/70 treated patients (90%). Median CD4+ cells were 618/μl (130–1635 cells/μl). Alcohol consumption was >24 g/day (males) or >12 g/day (females) in 11% of patients, 41% were smokers, and 17% reported consumption of recreational drugs. Median liver stiffness was 5.2 kPa (3.1 – 8.8 kPa). No/minimal fibrosis was found in 70/79 (89%), moderate fibrosis in 9/79 (11%). No patient had severe fibrosis or cirrhosis. With FIB-4 62/81 (77%) patients had no/minimal fibrosis, 18/81 (22%) moderate fibrosis and 1/81 (1%) advanced fibrosis.


In this ongoing study about 20% of HIV-mono-infected patients had elevated ALT. Advanced liver fibrosis was rare in this cohort of HIV-mono-infected individuals, and there is good agreement between FibroScan and FIB-4.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mauss, S., Henke, J., Berger, F. et al. Screening for liver fibrosis in HIV-mono-infected patients with increased ALT comparing FibroScan with FIB-4. JIAS 11, P135 (2008).

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  • Liver Fibrosis
  • Liver Stiffness
  • Recreational Drug
  • Advanced Fibrosis
  • Severe Fibrosis