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Liver fibrosis: concordance analysis between APRI and FIB-4 scores, evolution and predictors in a cohort of HIV patients without HCV and HBV infection
© Focà et al; licensee BioMed Central Ltd. 2010
Published: 8 November 2010
Purpose of the study
Liver fibrosis (LF) progression is fated to become one of the major long-term complications in HIV patients, even in those without HCV or HBV co-infections (HIV-mono-infected). The aim of this study was to assess LF progression in HIV-mono-infected patients and associated risk factors.
Observational retrospective study. All HIV naive patients who started HAART from 1996 to 2006 were included. Concordance between FIB-4 and APRI scores was assessed using the weighted kappa coefficient. Rates of transition from lower classes to higher classes were estimated by Kaplan-Meier analysis. Cox regression models were applied to assess possible predictors both at baseline and during the follow-up.
Summary of results
1,112 naive patients were selected. A moderate concordance between FIB-4 and APRI was demonstrated (K=0.573). For FIB-4, the incidence of transition to higher classes was 0.064 PYFU (95% CI, 0.056-0.072), while for APRI the incidence of transition was 0.099 PYFU (95% CI, 0.089-0.110). Viro-immunological control during HIV infection appeared to reduce the risk of both FIB-4 and APRI transitions. HIV-RNA <500 copies/ml (for FIB-4: HR 2.456 p<0.0001; for APRI: HR 2.084 p<0.0001) and higher CD4 T-cell counts only for FIB-4 (HR 0.881 p=0.0004 for 100 cells higher) during the follow-up were statistically protective. Among baseline variables, for FIB-4 transition, age ≥ 40 years (HR 1.037 p<0.0001) and higher FIB-4 values (HR 1.526 p=0.0038) were associated with increased risk of LF progression, while sexual risk factor for HIV acquisition resulted to be protective (HR 0.524 p=0.0314). For APRI, male gender (HR 1.390 p=0.017), higher GGT values (HR 1.015 p=0.014) and higher APRI values (HR 1.748 p=0.007) were independently associated with APRI transition. A sensitivity analysis demonstrated that DDX drugs (stavudine, didanosine, zalcitabine)as time-dependent covariates were associated with a significant risk of transition with FIB-4 (HR 1.662 p=0.0007) or APRI (HR 1.661 p=0.0001)
Our data suggest that a better viro-immunological control of HIV infection may slow down fibrosis progression provided that DDX are avoided. Moreover our analysis provided a comprehensive feature of the risk factors that should be controlled in clinical practice
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.