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Published on: January 5, 2016
Use of the AST to platelet ratio index in HCV/HIV co-infected patients
A G Singal1, L V Thomassen, D R Gretch
1Department of Medicine, University of Texas Southwestern Medical Center, Dallas, 75390-8887, USA. amit.singal@utsouthwestern.edu
Background:
The AST to platelet ratio index (APRI), a non-invasive marker of liver fibrosis, has not been well studied in HCV/HIV (hepatitis C virus/human immunodeficiency virus) co-infected patients with advanced HIV.
Aim:
To compare the accuracy of APRI in HCV/HIV co-infected patients to that in HCV mono-infected patients and to determine the impact of CD4+ T-cell counts on its performance.
Methods:
We identified 106 consecutive HCV/HIV co-infected patients and 105 matched HCV mono-infected patients who underwent liver biopsy at Harborview Medical Center over a 5-year period. Performance characteristics were calculated and receiver operating characteristic (ROC) analysis conducted.
Results:
The area under the ROC curve (AUROC) of APRI for predicting significant fibrosis was similar when comparing those with and without HIV co-infection (0.77 vs. 0.86, P = 0.18), but was lower in HIV co-infected patients with CD4 counts <250 cells/mm³ (0.64 vs. 0.86, P = 0.05). In HIV co-infected patients with CD4 counts ≥250, APRI had higher negative predictive value (93% vs. 88%, P = 0.57), positive predictive value (63% vs. 40%, P = 0.43) and specificity (95% vs. 88%, P = 0.05) than in those with lower CD4 counts.
Conclusions:
The AST to platelet ratio index (APRI) performance characteristics appear to be suboptimal in HCV/HIV co-infected patients with CD4 counts <250 and they require further study in this population at increased risk for advanced liver disease.
