Assessment of liver fibrosis and associated risk factors in HIV-infected individuals using transient elastography and serum biomarkers

BMC Gastroenterology

Research Article

Thierry Poynard¹  Axel Mueller²  Amina Carlebach²  Peter Gute²  Thomas Lutz²  Gaby Knecht²  Eva Herrmann³  Annika Vermehren⁴  Stefan Zeuzem⁴  Nicole Forestier⁴  Mireen Friedrich-Rust⁴  Christoph Sarrazin⁴  Johannes Vermehren⁴  Wolf Peter Hofmann⁵ 

[1] Hôpital Pitié Salpétrière, Paris, France;Infektiologikum, Frankfurt am Main, Germany;Institut für Biostatistik und mathematische Modellierung, Fachbereich Medizin der J. W. Goethe-Universität, Frankfurt am Main, Germany;Medizinische Klinik 1, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany;Medizinische Klinik 1, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany;POLIKUM Gesundheitszentren, Berlin, Germany;

关键词: HIV;    HCV;    co-infection;    cART;    Hepatotoxicity;    Transient elastography;    Fibrotest;    Liver enzymes;   

DOI  :  10.1186/1471-230X-12-27

 received in 2011-10-22, accepted in 2012-03-27,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundLiver fibrosis in human immunodeficiency virus (HIV)-infected individuals is mostly attributable to co-infection with hepatitis B or C. The impact of other risk factors, including prolonged exposure to combined antiretroviral therapy (cART) is poorly understood. Our aim was to determine the prevalence of liver fibrosis and associated risk factors in HIV-infected individuals based on non-invasive fibrosis assessment using transient elastography (TE) and serum biomarkers (Fibrotest [FT]).MethodsIn 202 consecutive HIV-infected individuals (159 men; mean age 47 ± 9 years; 35 with hepatitis-C-virus [HCV] co-infection), TE and FT were performed. Repeat TE examinations were conducted 1 and 2 years after study inclusion.ResultsSignificant liver fibrosis was present in 16% and 29% of patients, respectively, when assessed by TE (≥ 7.1 kPa) and FT (> 0.48). A combination of TE and FT predicted significant fibrosis in 8% of all patients (31% in HIV/HCV co-infected and 3% in HIV mono-infected individuals). Chronic ALT, AST and γ-GT elevation was present in 29%, 20% and 51% of all cART-exposed patients and in 19%, 8% and 45.5% of HIV mono-infected individuals. Overall, factors independently associated with significant fibrosis as assessed by TE (OR, 95% CI) were co-infection with HCV (7.29, 1.95-27.34), chronic AST (6.58, 1.30-33.25) and γ-GT (5.17, 1.56-17.08) elevation and time on dideoxynucleoside therapy (1.01, 1.00-1.02). In 68 HIV mono-infected individuals who had repeat TE examinations, TE values did not differ significantly during a median follow-up time of 24 months (median intra-patient changes at last TE examination relative to baseline: -0.2 kPa, p = 0.20).ConclusionsChronic elevation of liver enzymes was observed in up to 45.5% of HIV mono-infected patients on cART. However, only a small subset had significant fibrosis as predicted by TE and FT. There was no evidence for fibrosis progression during follow-up TE examinations.

【 授权许可】

Unknown   
© Vermehren et al; licensee BioMed Central Ltd. 2012. 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.