Use of the AST to platelet ratio index in HCV/HIV co-infected patients

A. G. Singal, L. V. Thomassen, D. R. Gretch, M. C. Shuhart

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)566-577
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Volume33
Issue number5
DOIs
StatePublished - Mar 2011

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Hepacivirus
Blood Platelets
HIV
CD4 Lymphocyte Count
ROC Curve
Coinfection
Liver Cirrhosis
HIV Infections
Liver Diseases
Fibrosis
T-Lymphocytes
Biopsy
Liver

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Use of the AST to platelet ratio index in HCV/HIV co-infected patients. / Singal, A. G.; Thomassen, L. V.; Gretch, D. R.; Shuhart, M. C.

In: Alimentary Pharmacology and Therapeutics, Vol. 33, No. 5, 03.2011, p. 566-577.

Research output: Contribution to journalArticle

Singal, A. G. ; Thomassen, L. V. ; Gretch, D. R. ; Shuhart, M. C. / Use of the AST to platelet ratio index in HCV/HIV co-infected patients. In: Alimentary Pharmacology and Therapeutics. 2011 ; Vol. 33, No. 5. pp. 566-577.
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N2 - 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.

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