Comparison of transient elastography and liver biopsy for the assessment of liver fibrosis in HIV/hepatitis C virus-coinfected patients and correlation with noninvasive serum markers M. Sa ´nchez-Conde, 1 M. L. Montes-Ramı ´rez, 2 P. Miralles, 1 J. M. Castro Alvarez, 2 J. M. Bello ´n, 1 M. Ramı ´rez, 1 J. R. Arribas, 2 I. Gutie ´rrez, 1 J. C. Lo ´pez, 1 J. Cosı ´n, 1 E. Alvarez, 1 J. Gonza ´lez 2 and J. Berenguer 1 1 Hospital Gregorio Maran ˜o ´n, Madrid, Spain; and 2 Hospital La Paz, Madrid, Spain Received April 2009; accepted for publication June 2009 SUMMARY. Transient elastography (FibroScan Ò ) is a novel, rapid and noninvasive technique to assess liver fibrosis. Our objective was to compare transient elastography (TE) and other noninvasive serum indexes as alternatives to liver biopsy in HIV/hepatitis C virus (HCV)-coinfected patients. The fibrosis stage (METAVIR Score), TE, the aspartate aminotransferase-to-platelet ratio index, the Forns fibrosis index, FIB-4 and HGM-2 indexes were assessed in 100 patients between January 2007 and January 2008. The diagnostic values were compared by calculating the area under the receiver operating characteristic curves (AUROCs). Using TE, the AUROC (95% CI) of liver stiffness was 0.80 (0.72–0.89) when discriminating between F £ 1 and F > 2, 0.93 (0.85–1.00) when discriminating between F £ 2 and F > 3 and 0.99 (0.97–1.00) when discrimina- ting between F £ 3 and F4. For the diagnosis of F ‡ 3, the AUROCs of TE were significantly higher than those obtained with the other four noninvasive indexes. Based on receiver operating characteristic curves, three cutoff values were chosen to identify F £ 1 (<7 kPa), F ‡ 3(‡11 kPa) and F4 (‡14 kPa). Using these best cutoff scores, the negative predictive value and positive predictive value were 81.1% and 70.2% for the diagnosis of F £ 1, 96.3% and 60% for the diagnosis of F ‡ 3 and 100% and 57.1% for the diagnosis of F4. Thus, Transient elastography accu- rately predicted liver fibrosis and outperformed other simple noninvasive indexes in HIV/HCV-coinfected patients. Our data suggest that TE is a helpful tool for guiding therapeutic decisions in clinical practice. Keywords: biological markers/blood, diagnostic techniques, digestive system, hepatitis C, chronic/complications, HIV infections/complications, liver cirrhosis/diagnosis/etiology, liver/pathology. INTRODUCTION The HIV infection modifies the natural history of chronic hepatitis C, thus promoting more rapid progression to cirrhosis and end-stage liver disease [1–3]. Since the intro- duction of highly active antiretroviral therapy (HAART), chronic liver disease because of the hepatitis C virus (HCV) has become one of the most clinically relevant comorbid conditions in the HIV-infected population [4,5]. For this reason, all HIV-infected individuals with positive HCV-RNA should be considered as candidates for anti-HCV treatment, providing HIV infection is well controlled and there are no contraindications to therapy with interferon or ribavirin [6]. Staging liver biopsy samples is considered an essential part of the management of patients with chronic hepatitis C because it provides prognostic information and, in many cases, assists in therapeutic decisions [7]. This is particularly true in HIV/HCV-coinfected patients because of the overall lower response to anti-HCV therapy and the potential inter- actions between antiretroviral and anti-HCV drugs [8–10]. Because fibrosis implies morphological damage, liver biopsy has come to be considered the best standard for the assessment of liver fibrosis [11]. However, it has several limitations, including patient reluctance, adverse events, accessibility, cost, sampling error and interobserver vari- ability [12–14]. In recent years, these limitations have led to Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; APRI, AST-to-platelet ratio index; AUROCs, area under the receiver operating characteristic curves; GGT, gamma glutamyl transferase; HCV, hepatitis C virus; HAART, highly active antiretroviral therapy; INR, international normalized ratio; IQR, interquartile range; NLR, negative likelihood ratio; NPV, negative predictive values; PPV, positive predictive value; TE, transient elastography. Correspondence: Matilde Sa ´nchez-Conde, Unidad de Enfermedades Infecciosas/VIH (4100), Hospital Gregorio Maran ˜o ´n, Doctor Esquerdo, 46, 28007 Madrid, Spain. E-mail: msconde@gmail.com Journal of Viral Hepatitis, 2010, 17, 280–286 doi:10.1111/j.1365-2893.2009.01180.x Ó 2009 Blackwell Publishing Ltd