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Non-Invasive Serum Biomarkers Used to Stage Liver Fibrosis in Brazilian HIV/HCV-Coinfected Individuals
Bianca Peixoto Dantas1,2, Mariana Cavalheiro Magri1,2, Caroline Manchiero1,2
1Laboratorio de Investigacao Medica em Hepatologia por Virus (LIM-47), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
Background:
HIV/HCV coinfection accelerates liver fibrosis progression and increases liver-related morbidity and mortality. In Brazil, where chronic liver diseases remain a major public health concern and access to specialized diagnostic methods may be limited, accurate non-invasive biomarkers are essential for assessing liver fibrosis. However, data validating these biomarkers and establishing optimal cut-off values for Brazilian individuals with HIV/HCV coinfection remain scarce.
Methods:
We retrospectively evaluated 109 HIV/HCV coinfected individuals. APRI, FIB-4, FibroIndex, Forns, GUCI, and Lok index were calculated from patients' electronic medical records. Diagnostic accuracy was assessed using area under the receiver operating characteristic curve (AUROC) analysis, with liver biopsy as the reference standard. Optimal cohort-specific cut-off values were derived for each biomarker.
Results:
For cirrhosis, the highest diagnostic accuracy was observed for Lok (AUROC=0.893; cut-off >0.4570), FibroIndex (0.869; >1.9092), FIB-4 (0.849; >1.6555), GUCI (0.841; >1.0323), and APRI (0.822; >1.0212). For advanced fibrosis, the highest diagnostic accuracy was observed for FibroIndex (AUROC=0.871; cut-off >1.7183), FIB-4 (0.838; >1.6555), GUCI (0.836; >1.0323), Lok (0.836; >0.3865), and APRI (0.824; >1.0179). For significant fibrosis, the highest diagnostic accuracy was observed for GUCI (AUROC=0.822; cut-off >1.0323), APRI (0.817; >0.9948), and FIB-4 (0.806; >1.5118).
Discussion:
For the assessment of advanced fibrosis and cirrhosis, most of the evaluated biomarkers achieved AUROC >0.80, indicating very good diagnostic performance. These findings support the use of non-invasive biomarkers as practical tools for screening individuals at increased risk of chronic liver disease, including those with viral hepatitis.
Conclusions:
Non-invasive fibrosis biomarkers showed robust diagnostic performance for identifying advanced fibrosis and cirrhosis in Brazilian HIV/HCV coinfected individuals.