Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-Hepatitis C virus coinfection

Gregory D Kirk, Jacquie Astemborski, Shruti Hemendra Mehta, Chuck Spoler, Cedric Fisher, Danisha Allen, Yvonne Higgins, Richard D Moore, Nezem Afdhal, Michael Torbenson, Mark Sulkowski, David L Thomas

Research output: Contribution to journalArticle

Abstract

Background. Transient elastography is a novel, noninvasive method for staging liver fibrosis. We compared elastography with histologic methods among hepatitis C virus (HCV)-infected and human immunodeficiency virus (HIV)-HCV-coinfected participants in an urban, predominantly black study population. Methods. Participants recruited from the AIDS Linked to the Intravenous Experience and the Johns Hopkins HIV Clinical Cohort studies underwent elastography to determine liver stiffness measurements. Liver biopsy specimens were staged F0-F4 in accordance with the Metavir score. Diagnostic accuracy and determination of liver stiffness cutoff values, compared with histologic methods, were determined by receiver operating characteristic analysis. Logistic regression methods identified parameters associated with discordant classification status. Results. Of 192 participants, 139 (72%) were coinfected with HIV and HCV, 121 (63%) had insignificant fibrosis, and 48 (25%) had cirrhosis. Overall, the area-under-the-curve receiver operating characteristic was 0.87 for detection of both significant fibrosis (95% confidence interval, 0.82-0.92) and cirrhosis (95% confidence interval, 0.81-0.93). With use of cutoff values of ≥9.3 kPa for fibrosis and ≥ 12.3 kPa for cirrhosis, 79%-83% of participants were correctly classified by liver stiffness measurement (compared with histologic methods); accuracy appeared to be higher among HIV-uninfected participants than among HIV-infected participants. Most discordance occurred when liver stiffness measurements indicated liver disease and histologic examination did not (in 16% of participants); the patients with these discordant results were more likely to have attributes that increased the odds of significant fibrosis, such as elevated serum fibrosis markers or HIV-related immunosuppression, compared with persons in whom low fibrosis was predicted by both examination of a biopsy specimen and elastography. Conclusions. For most HCV-infected persons, fibrosis stage predicted by elastography is similar to that predicted by examination of a biopsy specimen. Elastography-based measurement of liver stiffness holds promise to expand liver disease screening and monitoring, particularly among injection drug users.

Original languageEnglish (US)
Pages (from-to)963-972
Number of pages10
JournalClinical Infectious Diseases
Volume48
Issue number7
DOIs
StatePublished - Apr 1 2009

Fingerprint

Elasticity Imaging Techniques
Virus Diseases
Coinfection
Hepacivirus
Liver Cirrhosis
Fibrosis
HIV
Liver
Biopsy
ROC Curve
Liver Diseases
Confidence Intervals
Drug Users
Immunosuppression
Area Under Curve
Acquired Immunodeficiency Syndrome
Cohort Studies
Biomarkers
Logistic Models

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-Hepatitis C virus coinfection. / Kirk, Gregory D; Astemborski, Jacquie; Mehta, Shruti Hemendra; Spoler, Chuck; Fisher, Cedric; Allen, Danisha; Higgins, Yvonne; Moore, Richard D; Afdhal, Nezem; Torbenson, Michael; Sulkowski, Mark; Thomas, David L.

In: Clinical Infectious Diseases, Vol. 48, No. 7, 01.04.2009, p. 963-972.

Research output: Contribution to journalArticle

Kirk, Gregory D ; Astemborski, Jacquie ; Mehta, Shruti Hemendra ; Spoler, Chuck ; Fisher, Cedric ; Allen, Danisha ; Higgins, Yvonne ; Moore, Richard D ; Afdhal, Nezem ; Torbenson, Michael ; Sulkowski, Mark ; Thomas, David L. / Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-Hepatitis C virus coinfection. In: Clinical Infectious Diseases. 2009 ; Vol. 48, No. 7. pp. 963-972.
@article{c66b45befb4f4a8f833d5534199a9c0d,
title = "Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-Hepatitis C virus coinfection",
abstract = "Background. Transient elastography is a novel, noninvasive method for staging liver fibrosis. We compared elastography with histologic methods among hepatitis C virus (HCV)-infected and human immunodeficiency virus (HIV)-HCV-coinfected participants in an urban, predominantly black study population. Methods. Participants recruited from the AIDS Linked to the Intravenous Experience and the Johns Hopkins HIV Clinical Cohort studies underwent elastography to determine liver stiffness measurements. Liver biopsy specimens were staged F0-F4 in accordance with the Metavir score. Diagnostic accuracy and determination of liver stiffness cutoff values, compared with histologic methods, were determined by receiver operating characteristic analysis. Logistic regression methods identified parameters associated with discordant classification status. Results. Of 192 participants, 139 (72{\%}) were coinfected with HIV and HCV, 121 (63{\%}) had insignificant fibrosis, and 48 (25{\%}) had cirrhosis. Overall, the area-under-the-curve receiver operating characteristic was 0.87 for detection of both significant fibrosis (95{\%} confidence interval, 0.82-0.92) and cirrhosis (95{\%} confidence interval, 0.81-0.93). With use of cutoff values of ≥9.3 kPa for fibrosis and ≥ 12.3 kPa for cirrhosis, 79{\%}-83{\%} of participants were correctly classified by liver stiffness measurement (compared with histologic methods); accuracy appeared to be higher among HIV-uninfected participants than among HIV-infected participants. Most discordance occurred when liver stiffness measurements indicated liver disease and histologic examination did not (in 16{\%} of participants); the patients with these discordant results were more likely to have attributes that increased the odds of significant fibrosis, such as elevated serum fibrosis markers or HIV-related immunosuppression, compared with persons in whom low fibrosis was predicted by both examination of a biopsy specimen and elastography. Conclusions. For most HCV-infected persons, fibrosis stage predicted by elastography is similar to that predicted by examination of a biopsy specimen. Elastography-based measurement of liver stiffness holds promise to expand liver disease screening and monitoring, particularly among injection drug users.",
author = "Kirk, {Gregory D} and Jacquie Astemborski and Mehta, {Shruti Hemendra} and Chuck Spoler and Cedric Fisher and Danisha Allen and Yvonne Higgins and Moore, {Richard D} and Nezem Afdhal and Michael Torbenson and Mark Sulkowski and Thomas, {David L}",
year = "2009",
month = "4",
day = "1",
doi = "10.1086/597350",
language = "English (US)",
volume = "48",
pages = "963--972",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-Hepatitis C virus coinfection

AU - Kirk, Gregory D

AU - Astemborski, Jacquie

AU - Mehta, Shruti Hemendra

AU - Spoler, Chuck

AU - Fisher, Cedric

AU - Allen, Danisha

AU - Higgins, Yvonne

AU - Moore, Richard D

AU - Afdhal, Nezem

AU - Torbenson, Michael

AU - Sulkowski, Mark

AU - Thomas, David L

PY - 2009/4/1

Y1 - 2009/4/1

N2 - Background. Transient elastography is a novel, noninvasive method for staging liver fibrosis. We compared elastography with histologic methods among hepatitis C virus (HCV)-infected and human immunodeficiency virus (HIV)-HCV-coinfected participants in an urban, predominantly black study population. Methods. Participants recruited from the AIDS Linked to the Intravenous Experience and the Johns Hopkins HIV Clinical Cohort studies underwent elastography to determine liver stiffness measurements. Liver biopsy specimens were staged F0-F4 in accordance with the Metavir score. Diagnostic accuracy and determination of liver stiffness cutoff values, compared with histologic methods, were determined by receiver operating characteristic analysis. Logistic regression methods identified parameters associated with discordant classification status. Results. Of 192 participants, 139 (72%) were coinfected with HIV and HCV, 121 (63%) had insignificant fibrosis, and 48 (25%) had cirrhosis. Overall, the area-under-the-curve receiver operating characteristic was 0.87 for detection of both significant fibrosis (95% confidence interval, 0.82-0.92) and cirrhosis (95% confidence interval, 0.81-0.93). With use of cutoff values of ≥9.3 kPa for fibrosis and ≥ 12.3 kPa for cirrhosis, 79%-83% of participants were correctly classified by liver stiffness measurement (compared with histologic methods); accuracy appeared to be higher among HIV-uninfected participants than among HIV-infected participants. Most discordance occurred when liver stiffness measurements indicated liver disease and histologic examination did not (in 16% of participants); the patients with these discordant results were more likely to have attributes that increased the odds of significant fibrosis, such as elevated serum fibrosis markers or HIV-related immunosuppression, compared with persons in whom low fibrosis was predicted by both examination of a biopsy specimen and elastography. Conclusions. For most HCV-infected persons, fibrosis stage predicted by elastography is similar to that predicted by examination of a biopsy specimen. Elastography-based measurement of liver stiffness holds promise to expand liver disease screening and monitoring, particularly among injection drug users.

AB - Background. Transient elastography is a novel, noninvasive method for staging liver fibrosis. We compared elastography with histologic methods among hepatitis C virus (HCV)-infected and human immunodeficiency virus (HIV)-HCV-coinfected participants in an urban, predominantly black study population. Methods. Participants recruited from the AIDS Linked to the Intravenous Experience and the Johns Hopkins HIV Clinical Cohort studies underwent elastography to determine liver stiffness measurements. Liver biopsy specimens were staged F0-F4 in accordance with the Metavir score. Diagnostic accuracy and determination of liver stiffness cutoff values, compared with histologic methods, were determined by receiver operating characteristic analysis. Logistic regression methods identified parameters associated with discordant classification status. Results. Of 192 participants, 139 (72%) were coinfected with HIV and HCV, 121 (63%) had insignificant fibrosis, and 48 (25%) had cirrhosis. Overall, the area-under-the-curve receiver operating characteristic was 0.87 for detection of both significant fibrosis (95% confidence interval, 0.82-0.92) and cirrhosis (95% confidence interval, 0.81-0.93). With use of cutoff values of ≥9.3 kPa for fibrosis and ≥ 12.3 kPa for cirrhosis, 79%-83% of participants were correctly classified by liver stiffness measurement (compared with histologic methods); accuracy appeared to be higher among HIV-uninfected participants than among HIV-infected participants. Most discordance occurred when liver stiffness measurements indicated liver disease and histologic examination did not (in 16% of participants); the patients with these discordant results were more likely to have attributes that increased the odds of significant fibrosis, such as elevated serum fibrosis markers or HIV-related immunosuppression, compared with persons in whom low fibrosis was predicted by both examination of a biopsy specimen and elastography. Conclusions. For most HCV-infected persons, fibrosis stage predicted by elastography is similar to that predicted by examination of a biopsy specimen. Elastography-based measurement of liver stiffness holds promise to expand liver disease screening and monitoring, particularly among injection drug users.

UR - http://www.scopus.com/inward/record.url?scp=63649132928&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63649132928&partnerID=8YFLogxK

U2 - 10.1086/597350

DO - 10.1086/597350

M3 - Article

VL - 48

SP - 963

EP - 972

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 7

ER -