Coinfection by human immunodeficiency virus and hepatitis C virus: noninvasive assessment and staging of fibrosis

Purpose of review This review presents recent findings on noninvasive alternatives for the diagnosis of fibrosis and cirrhosis in patients who are coinfected with HIV and hepatitis C virus (HCV). Recent findings APRI, FIB-4, and Forns were accurate indices for the diagnosis of cirrhosis [area under the receiver operating characteristic curve (AUROC) >0.80] but not for the diagnosis of significant and advanced fibrosis (AUROC < 0.80). Diagnostic accuracy was affected by CD4(+) T-cell count and alanine aminotransferase levels. An artificial neural network to predict significant fibrosis was highly accurate (AUROC of 0.853), outperforming simple noninvasive indices. Derivations of the FibroMeter panel (FibroMeter(2G) HICV and FibroMeter(3G) HICV) achieved high diagnostic accuracy for significant fibrosis (AUROC of 0.823 and 0.833, respectively). Transient elastography had higher predictive accuracy than previously validated panels for diagnosis of advanced fibrosis (F > 3) and cirrhosis (0.93 and 0.99, respectively). However, misclassification as F >= 3 was more common among patients with steatosis than among those without steatosis (25 versus 5%, P = 0.01). Moreover, transient elastography can predict clinically significant and severe portal hypertension in HIV/HCV-coinfected patients. Summary Both biomarkers and transient elastography can accurately diagnose fibrosis and cirrhosis and are better at excluding than at predicting liver disease in HIV/HCV-coinfected patients.