Diagnostic Accuracy of Noninvasive Markers of Steatosis, NASH, and Liver Fibrosis in HIV-Monoinfected Individuals at Risk of Nonalcoholic Fatty Liver Disease (NAFLD): Results From the ECHAM Study
Standard
Diagnostic Accuracy of Noninvasive Markers of Steatosis, NASH, and Liver Fibrosis in HIV-Monoinfected Individuals at Risk of Nonalcoholic Fatty Liver Disease (NAFLD): Results From the ECHAM Study. / Lemoine, Maud; Assoumou, Lambert; De Wit, Stephane; Girard, Pierre-Marie; Valantin, Marc Antoine; Katlama, Christine; Necsoi, Coca; Campa, Pauline; Huefner, Anja D; Schulze Zur Wiesch, Julian; Rougier, Hayette; Bastard, Jean-Philippe; Stocker, Hartmut; Mauss, Stefan; Serfaty, Lawrence; Ratziu, Vlad; Menu, Yves; Schlue, Jerome; Behrens, Georg; Bedossa, Pierre; Capeau, Jacqueline; Ingiliz, Patrick; Costagliola, Dominique; ANRS-ECHAM Group.
In: JAIDS-J ACQ IMM DEF, Vol. 80, No. 4, 01.04.2019, p. e86-e94.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Diagnostic Accuracy of Noninvasive Markers of Steatosis, NASH, and Liver Fibrosis in HIV-Monoinfected Individuals at Risk of Nonalcoholic Fatty Liver Disease (NAFLD): Results From the ECHAM Study
AU - Lemoine, Maud
AU - Assoumou, Lambert
AU - De Wit, Stephane
AU - Girard, Pierre-Marie
AU - Valantin, Marc Antoine
AU - Katlama, Christine
AU - Necsoi, Coca
AU - Campa, Pauline
AU - Huefner, Anja D
AU - Schulze Zur Wiesch, Julian
AU - Rougier, Hayette
AU - Bastard, Jean-Philippe
AU - Stocker, Hartmut
AU - Mauss, Stefan
AU - Serfaty, Lawrence
AU - Ratziu, Vlad
AU - Menu, Yves
AU - Schlue, Jerome
AU - Behrens, Georg
AU - Bedossa, Pierre
AU - Capeau, Jacqueline
AU - Ingiliz, Patrick
AU - Costagliola, Dominique
AU - ANRS-ECHAM Group
PY - 2019/4/1
Y1 - 2019/4/1
N2 - BACKGROUND: HIV-monoinfected individuals are at high risk of nonalcoholic fatty liver disease. Noninvasive tests of steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), FibroScan/controlled attenuation parameter (CAP), and biochemical tests.METHODS: We enrolled antiretroviral therapy-controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, FibroScan/CAP, FibroTest/NashTest/SteatoTest, APRI, FIB-4, and nonalcoholic fatty liver disease-fibrosis score. A LB was indicated if suspected significant fibrosis (FibroScan ≥7.1 kPa and/or FibroTest ≥0.49). Performance was considered as good if area under a receiver operating characteristic curves (AUROCs) was >0.80.RESULTS: Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age of 54 years (53-65), body mass index: 26 kg/m (24-30), steatosis in 37 (76%), NASH in 23 (47%), and fibrosis in 31 (63%) patients [F2: 7 (14%); F3: 6 (12%); and F4: 2 (4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROCs at 0.98 (95% confidence interval: 0.96 to 1.00) and 0.88 (0.76 to 0.99), respectively, whereas the AUROCs of SteatoTest was 0.68 (0.51 to 0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROCs at 0.86 (0.74 to 0.98) and 0.81 (0.67 to 0.95). By contrast, FibroScan and FibroTest had poor AUROCs [0.61 (0.43 to 0.79) and 0.61 (0.44 to 0.78)], with very low specificity. Regarding NASH, alanine aminotransferase ≥36 IU/L had good performance with AUROCs of 0.83 (0.71 to 0.94), whereas the NashTest had an AUROC of 0.60 (0.44 to 0.76).CONCLUSIONS: In HIV-monoinfected patients, MRI-PDFF and FibroScan/CAP are highly accurate for the diagnosis of steatosis. The alanine aminotransferase level and APRI should be considered for the detection of NASH and fibrosis.
AB - BACKGROUND: HIV-monoinfected individuals are at high risk of nonalcoholic fatty liver disease. Noninvasive tests of steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), FibroScan/controlled attenuation parameter (CAP), and biochemical tests.METHODS: We enrolled antiretroviral therapy-controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, FibroScan/CAP, FibroTest/NashTest/SteatoTest, APRI, FIB-4, and nonalcoholic fatty liver disease-fibrosis score. A LB was indicated if suspected significant fibrosis (FibroScan ≥7.1 kPa and/or FibroTest ≥0.49). Performance was considered as good if area under a receiver operating characteristic curves (AUROCs) was >0.80.RESULTS: Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age of 54 years (53-65), body mass index: 26 kg/m (24-30), steatosis in 37 (76%), NASH in 23 (47%), and fibrosis in 31 (63%) patients [F2: 7 (14%); F3: 6 (12%); and F4: 2 (4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROCs at 0.98 (95% confidence interval: 0.96 to 1.00) and 0.88 (0.76 to 0.99), respectively, whereas the AUROCs of SteatoTest was 0.68 (0.51 to 0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROCs at 0.86 (0.74 to 0.98) and 0.81 (0.67 to 0.95). By contrast, FibroScan and FibroTest had poor AUROCs [0.61 (0.43 to 0.79) and 0.61 (0.44 to 0.78)], with very low specificity. Regarding NASH, alanine aminotransferase ≥36 IU/L had good performance with AUROCs of 0.83 (0.71 to 0.94), whereas the NashTest had an AUROC of 0.60 (0.44 to 0.76).CONCLUSIONS: In HIV-monoinfected patients, MRI-PDFF and FibroScan/CAP are highly accurate for the diagnosis of steatosis. The alanine aminotransferase level and APRI should be considered for the detection of NASH and fibrosis.
KW - Adipokines/blood
KW - Aged
KW - Anti-Retroviral Agents/therapeutic use
KW - Belgium
KW - Elasticity Imaging Techniques
KW - Female
KW - France
KW - Germany
KW - HIV Infections/drug therapy
KW - Humans
KW - Liver Cirrhosis/diagnosis
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Non-alcoholic Fatty Liver Disease/diagnosis
KW - Prospective Studies
KW - Ultrasonography
U2 - 10.1097/QAI.0000000000001936
DO - 10.1097/QAI.0000000000001936
M3 - SCORING: Journal article
C2 - 30570529
VL - 80
SP - e86-e94
JO - JAIDS-J ACQ IMM DEF
JF - JAIDS-J ACQ IMM DEF
SN - 1525-4135
IS - 4
ER -