  Citation: Rossetti, B.; Borgo, V.; Emiliozzi, A.; Colaneri, M.; Zanelli, G.; d’Alessandro, M.; Motta, D.; Maiocchi, L.; Montagnani, F.; Moioli, M.C.; et al. Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection. Diagnostics 2022, 12, 14. https:// doi.org/10.3390/diagnostics12010014 Academic Editors: Carmen de Mendoza and Laurent Bélec Received: 11 November 2021 Accepted: 17 December 2021 Published: 22 December 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). diagnostics Article Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection Barbara Rossetti 1, *, Valentina Borgo 1,2 , Arianna Emiliozzi 2 , Marta Colaneri 3 , Giacomo Zanelli 1,2 , Miriana d’Alessandro 4 , Davide Motta 5 , Laura Maiocchi 3 , Francesca Montagnani 1,2 , Maria Cristina Moioli 5 , Chiara Baiguera 5 , Margherita Sambo 3 , Teresa Chiara Pieri 3 , Pietro Valsecchi 3 , Raffaele Bruno 3 , Massimo Puoti 5 and Massimiliano Fabbiani 1 1 Infectious and Tropical Diseases Unit, Siena University Hospital, 53100 Siena, Italy; valentina.borgo1989@gmail.com (V.B.); giacomo.zanelli1971@gmail.com (G.Z.); francesca.montagnani@unisi.it (F.M.); massimiliano.fabbiani@gmail.com (M.F.) 2 Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; ariannaemiliozzi@gmail.com 3 Infectious Diseases I Unit, I.R.C.C.S. Policlinico San Matteo Foundation, 27100 Pavia, Italy; marta.colaneri@gmail.com (M.C.); L.Maiocchi@smatteo.pv.it (L.M.); sambomargherita@gmail.com (M.S.); teresachiara.pieri01@universitadipavia.it (T.C.P.); pietro.valsecchi01@universitadipavia.it (P.V.); raffaele.bruno@unipv.it (R.B.) 4 Respiratory Diseases and Lung Transplant Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100 Siena, Italy; dalessandro.miriana@gmail.com 5 Infectious Diseases Unit, Niguarda Hospital, 20162 Milan, Italy; davide.motta@ospedaleniguarda.it (D.M.); mariacristina.moioli@ospedaleniguarda.it (M.C.M.); chiara.baiguera@ospedaleniguarda.it (C.B.); massimo.puoti@ospedaleniguarda.it (M.P.) * Correspondence: brossetti1982@gmail.com; Tel.: +39-3201437658; Fax: +39-0577586580 Abstract: Severe liver fibrosis (LF) is associated with poor long-term liver-related outcomes in people living with HIV (PLWH). The study aimed to explore the prevalence and predictors of LF and the concordance between different non-invasive methods for the estimation of LF in HIV-infected individuals without hepatitis virus infection. We enrolled PLWH with HIV-1-RNA <50 copies/mL for >12 months, excluding individuals with viral hepatitis. LF was assessed by transient elastography (TE) (significant >6.65 kPa), fibrosis-4 (FIB-4) (significant >2.67), and AST-to-platelet ratio index (APRI) (significant >1.5). We included 234 individuals (67% males, median age 49 years, median time from HIV diagnosis 11 years, 38% treated with integrase strand transfer inhibitors). In terms of the TE, 13% had ≥F2 stage; FIB-4 score was >1.5 in 7%; and APRI > 0.5 in 4%. Higher body mass index, diabetes mellitus, detectable baseline HIV-1 RNA and longer atazanavir exposure were associated with higher liver stiffness as per TE. Predictors of higher APRI score were CDC C stage and longer exposure to tenofovir alafenamide, while HBcAb positivity and longer exposure to tenofovir alafenamide were associated to higher FIB-4 scores. Qualitative agreement was poor between FIB-4/TE and between APRI/TE by non-parametric Spearman correlation and kappa statistic. In our study, in the group of PLWH without viral hepatitis, different non-invasive methods were discordant in predicting liver fibrosis. Keywords: liver fibrosis; HIV; ART 1. Introduction Human immunodeficiency virus (HIV) infection is one of the most serious public health challenges, affecting approximately 37.6 million people across the globe in 2020, of whom 34 million are adults [1]. As a result of remarkable advances in scientific un- derstanding of HIV and its prevention and treatment, after the introduction of highly active antiretroviral treatment (HAART) back in 1996, the leading causes of morbidity and mortality among people living with HIV (PLWH) in high-income countries have switched Diagnostics 2022, 12, 14. https://doi.org/10.3390/diagnostics12010014 https://www.mdpi.com/journal/diagnostics