| | Comparison of liver fibrosis blood tests developed for HCV with new specific tests in HIV/HCV co-infectionReceived 8 October 2009; received in revised form 13 March 2010; accepted 17 March 2010. published online 26 April 2010.
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Serum fibrosis markers: Death by validation or a leap of faith?
, 11 May 2010
Vlad Ratziu
Journal of Hepatology
August 2010 (Vol. 53, Issue 2, Pages 222-224)
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Background & AimsWe compared 5 non-specific and 2 specific blood tests for liver fibrosis in HCV/HIV co-infection. ResultsUnadjusted AUROCs in the derivation population were: APRI: 0.716, Fib-4: 0.722, Fibrotest: 0.778, Hepascore: 0.779, FibroMeter: 0.783, HICV test: 0.822, FibroMeter HICV: 0.828. AUROCs adjusted on classification and distribution of fibrosis stages in a reference population showed similar values in both populations. FibroMeter, FibroMeter HICV and HICV test had the highest correct classification rates in F0/1 and F3/4 (which account for high predictive values): 77–79% vs. 70–72% in the other tests (p =0.002). Reliable individual diagnosis based on predictive values ⩾90% distinguished three test categories: poorly reliable: Fib-4 (2.4% of patients), APRI (8.9%); moderately reliable: Fibrotest (25.4%), FibroMeter (26.6%), Hepascore (30.2%); acceptably reliable: HICV test (40.2%), FibroMeter HICV (45.6%) (p<10−3 between tests). FibroMeter HICV classified all patients into four reliable diagnosis intervals (⩽F1, F1±1, ⩾F1, ⩾F2) with an overall accuracy of 93% vs. 79% (p<10−3) for a binary diagnosis of significant fibrosis. ConclusionsTests designed for HCV infections are less effective in HIV/HCV infections. A specific test, like FibroMeter HICV, was the most interesting test for diagnostic accuracy, correct classification profile, and a reliable diagnosis. With reliable diagnosis intervals, liver biopsy can therefore be avoided in all patients. Abbreviations: APRI, aspartate aminotransferase to platelet ratio index, AST, aspartate aminotransferase, AUROC, area under the receiver operating characteristic, CLD, chronic liver disease, HCV, hepatitis C virus, HICV, human immunodeficiency and C virus (used for HICV fibrosis test), HIV, human immunodeficiency virus, NPV, negative predictive value, PPV, positive predictive value 1 Hepatology Department, University Hospital, Angers, France 2 HIFIH Laboratory, UPRES 3859, IFR 132, Angers University, PRES UNAM, France 3 Alphabio Laboratory, Marseilles, France 4 Immunology Department, Hôpital Européen Georges Pompidou, Paris, France 5 INSERM, Unité de Recherche en Épidémiologie Systèmes d’Information et Modélisation (U707), Paris, F-75012, France 6 UPMC-Paris6, Faculté de Médecine Pierre et Marie Curie, UMR-S707, Paris, F-75012, France 7 Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, F-75012, France 8 Internal Medicine Department, CHG, La Roche/Yon, France 9 Hepatology Department, University Hospital, Rennes, France 10 Hepatology Department, University Hospital, Tours, France 11 Infectious Diseases Department, University Hospital, Rennes, France 12 Université Paris Descartes, Faculté de Médecine, Paris, France 13 Infectious Diseases, Internal Medicine Department, Hôpital Cochin, Paris, France 14 Department of Internal Medicine, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France 15 Pierre and Marie Curie (Paris 6) University, CNRS UMR7087, Paris, France  Corresponding author. Present address: Service d’Hépato-Gastroentérologie, CHU, 49933 Angers Cedex 09, France. Tel.: +33 2 41 35 34 10; fax: +33 2 41 35 41 19.
PII: S0168-8278(10)00271-0 doi:10.1016/j.jhep.2010.03.007 © 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved. | |
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ABSTRACT