Clinical

Elastography noninvasively assesses hepatic fibrosis in HIV/HVC patients

Last Updated: 2006-02-24 13:16:48 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Hepatic fibrosis in patients co-infected with HIV and hepatitis C virus (HCV) can be accurately assessed using transient elastography (FibroScan; Echosens, Paris), according to a report in the February 1st Journal of Acquired Immune Deficiency Syndromes.

"FibroScan is, so far, the best noninvasive method for the evaluation of liver fibrosis and cirrhosis and for the evaluation of the severity of cirrhosis," Dr. Victor de Ledinghen from Hopital Haut Leveque, Bordeaux, France told Reuters Health.

The FibroScan system applies a low amplitude, low frequency vibration to the tissue, which propagates an elastic shear wave through the liver. The speed of the propagation, which increases with increasing tissue hardness, is measured with pulsed ultrasound.

Dr. de Ledinghen and colleagues assessed the accuracy of transient elastography for the detection of fibrosis in 72 HIV-infected patients with chronic HCV infection and compared its accuracy with that of other noninvasive methods.

Liver stiffness as measured by FibroScan correlated significantly with fibrosis stage determined from liver biopsies, the investigators report.

A liver stiffness of 14.5 kilopascals or higher was 96.4% specific and had an 88.2% positive predictive value for diagnosing cirrhosis, the results indicate. The accuracy of transient elastography for the diagnosis of cirrhosis was significantly higher than that of other noninvasive methods, the researchers note, including platelet count, AST/ALT ratio, APRI index, and FIB-4 score.

"The study highlights the diagnostic utility of liver stiffness measurement for assessing liver fibrosis and detecting cirrhosis in HIV/HCV-coinfected patients," the authors conclude. "These results suggest that liver stiffness measurement could reliably be used for first-line pretherapeutic evaluation of fibrosis in coinfected patients."

"FibroScan should be the first step for the evaluation of fibrosis in HCV/HIV co-infected patients," Dr. de Ledinghen said. "It's only 5 minutes, noninvasive, at bedside, and there is no effect of drugs on the result."

He added, "The evaluation could be performed every year to evaluate fibrosis progression or fibrosis regression" in patients undergoing HCV treatment.

J Acquir Immune Defic Syndr 2006;41:175-179.