14th Annual Conference of the British HIV Association 23–25 April 2008, Belfast

ASSESSMENT OF STAGING OF LIVER FIBROSIS BY TRANSIENT ELASTOGRAPHY IN HIV-POSITIVE PATIENTS WITH CHRONIC LIVER DISEASE USING LIVER BIOPSY AS THE GOLD STANDARD

HIV Med 2008; 9(Suppl. 1):29 (abstract no. P72)

A Rodger¹, T Fernandez¹, G Slapak¹, G Dusheiko¹, MA Johnson¹, C Sabin² and S Bhagani^1
1Royal Free Hospital, London, UK, ²University College London, London, UK

BACKGROUND: Transient elastography is a non-invasive method of measuring liver fibrosis by measurement of liver stiffness. The technique has not been fully evaluated and there is little data in patients with HIV. The aim of this ongoing prospective study is to evaluate the accuracy of liver stiffness measurement in patients with HIV and liver disease using liver biopsy as the gold standard.

METHODS: Thirty HIV positive patients with chronic liver disease have been studied to date. Aetiologies of chronic liver disease were hepatitis B or C co-infection, alcohol or steatosis. Liver fibrosis was evaluated using the METAVIR scoring system. Fibroscan measures of <7.9 Kpa were used as the cut off for no or minimal fibrosis (F0/1) and >11.9Kpa as the cut off for severe fibrosis (F4).

RESULTS: Twelve subjects had liver biopsy scores of F0/1 and 16 had scores of F3/4 . Stiffness was significantly correlated to stage of fibrosis (r=0.68, P<0.0001). Median values for F0/F1 were 5.6 Kpa (range 3.6– 10.2) and for F4, 14.3 Kpa (range 7.8–67.9). Using a cut-off value of 11.9 KPa, patients with cirrhosis (F4) were detected with a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 91%. For moderate or severe fibrosis (>F2) a cut off of >7.9 Kpa gave a PPV of 92% and a NPV of 76%. Minimal fibrosis (F0/F1) was detected with a PPV of 61% and a NPV of 92%.

CONCLUSIONS: FibroScan is a reliable method for the diagnosis of significant fibrosis (>F2) and cirrhosis (F4) in HIV positive patients with chronic liver disease. This technique can effectively inform clinical decisions on the need to proceed to treatment for viral hepatitis coinfection or liver biopsy. The ability of fibroscan to monitor progression or regression of fibrosis over time in individual patients needs further assessment.

2008-04-23
P72

Copyright © 2008 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD