Correlation of transient elastography with APRI and FIB-4 in a cohort of patients with congenital bleeding disorders and HCV or HIV/HCV coinfection

Patients with inherited bleeding disorders frequently suffer from chronic hepatitis C virus (HCV) mono‐ or human immunodeficiency virus (HIV)/HCV coinfection. Non‐invasive markers for liver fibrosis are warranted for these patients. We tested a large cohort of haemophilic patients with HCV mono‐ or...

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Published in:	Haemophilia : the official journal of the World Federation of Hemophilia Vol. 16; no. 5; pp. 778 - 785
Main Authors:	VIDOVIC, N., LOCHOWSKY, R. S., GOLDMANN, G., ROCKSTROH, J., WASMUTH, J. C., SPENGLER, U., SAUERBRUCH, T., LAMMERT, F., OLDENBURG, J., GRÜNHAGE, F.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-09-2010
Subjects:	Adult Age Factors Aged Aged, 80 and over Aspartate Aminotransferases - blood Biomarkers - blood Biopsy Bleeding Body Mass Index Cohort Studies Data processing Elasticity Imaging Techniques - methods elastography Fibrosis haemophilia Hemophilia Hemophilia A - complications Hemophilia B - complications hepatitis C Hepatitis C - complications Hepatitis C virus HIV HIV Infections - complications Human immunodeficiency virus Humans Immune response Liver Liver Cirrhosis - blood Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver diseases Liver Function Tests Middle Aged non-invasive Platelet Count Platelets Severity of Illness Index Young Adult
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Summary:	Patients with inherited bleeding disorders frequently suffer from chronic hepatitis C virus (HCV) mono‐ or human immunodeficiency virus (HIV)/HCV coinfection. Non‐invasive markers for liver fibrosis are warranted for these patients. We tested a large cohort of haemophilic patients with HCV mono‐ or HIV/HCV coinfection for correlation of transient elastography (TE) with two simple surrogate markers of liver fibrosis and for differences in fibrosis stages according to these markers. We prospectively enrolled HCV‐positive patients with congenital bleeding disorders with or without HIV coinfection. Liver function tests and platelet counts were determined and TE was performed. Aspartate aminotransferase‐to‐platelet ratio index (APRI) and a simple index called FIB‐4 were calculated and results were correlated with TE. A total number of 174 patients were included (23% HCV, 36% HIV/HCV coinfected, 33% with cleared HCV and 8% with ongoing HIV but cleared HCV). TE correlated significantly with APRI and FIB‐4 (r = 0.60; P < 0.001 and r = 0.54; P < 0.001 respectively). This correlation was pronounced in patients with ongoing HCV infection (r = 0.67; P < 0.001 and r = 0.60; P < 0.001). Prediction of advanced fibrosis resulted in concordance rates >80% with combinations of TE plus APRI and APRI plus FIB‐4. HIV/HCV coinfected patients did not present with advanced fibrosis stages when compared with HCV‐monoinfected patients. Combinations of two non‐invasive markers may significantly reduce the number of liver biopsies in patients with bleeding disorders and advanced liver fibrosis. Furthermore, our data support previous studies that observed a favourable outcome in patients with HIV/HCV and a preserved immune function in times of highly active antiretroviral therapy.
Bibliography:	ArticleID:HAE2204 istex:42CC2FC2D58E53B4D33F1F471B4EBB60749DA5CB ark:/67375/WNG-TD0R217D-G NV and RSL contributed equally to the study. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1351-8216 1365-2516
DOI:	10.1111/j.1365-2516.2010.02204.x