Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients
Abstract Background After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibros...
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doaj-f0a425bac8d74823afd2518c029179f32020-11-25T03:43:26ZengBMCBMC Infectious Diseases1471-23342020-05-012011610.1186/s12879-020-05069-5Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patientsEvy Yunihastuti0Bramantya Wicaksana1Andrian Wiraguna2Ainum Jhariah Hidayah3Fhadilla Amelia4Veritea Natali5Alvina Widhani6Andri Sanityoso Sulaiman7Juferdy Kurniawan8HIV integrated services, Cipto Mangunkusumo HospitalHIV integrated services, Cipto Mangunkusumo HospitalHIV integrated services, Cipto Mangunkusumo HospitalHIV integrated services, Cipto Mangunkusumo HospitalHIV integrated services, Cipto Mangunkusumo HospitalHIV integrated services, Cipto Mangunkusumo HospitalHIV integrated services, Cipto Mangunkusumo HospitalDepartment of Internal Medicine, Faculty of Medicine Universitas IndonesiaDepartment of Internal Medicine, Faculty of Medicine Universitas IndonesiaAbstract Background After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard. Method This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. Results 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63–0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65–0.81)] and correctly classified 81.1% of the patients. Conclusion APRI score ≥ 1 and FIB-4 score ≥ 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.http://link.springer.com/article/10.1186/s12879-020-05069-5APRIFIB-4Transient elastographyHIVHCV |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Evy Yunihastuti Bramantya Wicaksana Andrian Wiraguna Ainum Jhariah Hidayah Fhadilla Amelia Veritea Natali Alvina Widhani Andri Sanityoso Sulaiman Juferdy Kurniawan |
spellingShingle |
Evy Yunihastuti Bramantya Wicaksana Andrian Wiraguna Ainum Jhariah Hidayah Fhadilla Amelia Veritea Natali Alvina Widhani Andri Sanityoso Sulaiman Juferdy Kurniawan Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients BMC Infectious Diseases APRI FIB-4 Transient elastography HIV HCV |
author_facet |
Evy Yunihastuti Bramantya Wicaksana Andrian Wiraguna Ainum Jhariah Hidayah Fhadilla Amelia Veritea Natali Alvina Widhani Andri Sanityoso Sulaiman Juferdy Kurniawan |
author_sort |
Evy Yunihastuti |
title |
Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients |
title_short |
Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients |
title_full |
Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients |
title_fullStr |
Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients |
title_full_unstemmed |
Diagnostic performance of APRI and FIB-4 for confirming cirrhosis in Indonesian HIV/HCV co-infected patients |
title_sort |
diagnostic performance of apri and fib-4 for confirming cirrhosis in indonesian hiv/hcv co-infected patients |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2020-05-01 |
description |
Abstract Background After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard. Method This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. Results 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63–0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65–0.81)] and correctly classified 81.1% of the patients. Conclusion APRI score ≥ 1 and FIB-4 score ≥ 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available. |
topic |
APRI FIB-4 Transient elastography HIV HCV |
url |
http://link.springer.com/article/10.1186/s12879-020-05069-5 |
work_keys_str_mv |
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