Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients
(1) Background: Developing strategies to identify significant liver fibrosis in people with HIV (PWH) is crucial to prevent complications of non-alcoholic fatty liver disease (NAFLD). We aim to investigate if five simple serum biomarkers applied to PWH can optimize a care pathway to identify signifi...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-02-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/2/282 |
| _version_ | 1797478843138703360 |
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| author | Giada Sebastiani Jovana Milic Adriana Cervo Sahar Saeed Thomas Krahn Dana Kablawi Al Shaima Al Hinai Bertrand Lebouché Philip Wong Marc Deschenes Claudia Gioè Antonio Cascio Giovanni Mazzola Giovanni Guaraldi |
| author_facet | Giada Sebastiani Jovana Milic Adriana Cervo Sahar Saeed Thomas Krahn Dana Kablawi Al Shaima Al Hinai Bertrand Lebouché Philip Wong Marc Deschenes Claudia Gioè Antonio Cascio Giovanni Mazzola Giovanni Guaraldi |
| author_sort | Giada Sebastiani |
| collection | DOAJ |
| description | (1) Background: Developing strategies to identify significant liver fibrosis in people with HIV (PWH) is crucial to prevent complications of non-alcoholic fatty liver disease (NAFLD). We aim to investigate if five simple serum biomarkers applied to PWH can optimize a care pathway to identify significant liver fibrosis defined by transient elastography (TE). (2) Methods: A two-tier fibrosis pathway was applied to three prospective cohorts of PWH undergoing TE with CAP. NAFLD was diagnosed as a controlled attenuation parameter ≥ 248 dB/m. Five simple fibrosis biomarkers (FIB-4 < 1.3, BARD score 0–1, NAFLD fibrosis score < −1.455, AST:ALT ratio < 0.8 and APRI < 0.5) were applied as first-tiers to exclude significant liver fibrosis. We determined the decrease in referral for TE that would have occurred based on biomarker assessment and the discordance between low simple fibrosis biomarkers and high TE (≥7.1 kPa), indicating significant liver fibrosis. (3) Results: Of the 1749 consecutive PWH, 15.1% had significant liver fibrosis by TE and 39.1% had NAFLD. The application of the fibrosis biomarkers as first tiers would have resulted in a decrease in TE referrals between 24.9% (BARD score) and 86.3% (APRI). The lowest discordance rate was with NAFLD fibrosis score (8.5%). After adjustments, BMI (odds ratio (OR) 1.12, 95% CI: 1.08–1.17) and triglycerides (OR 1.26, 95% CI: 1.11–1.44) were independent predictors of discordance for APRI < 0.5 and TE ≥ 7.1. The performance of the two-tier pathways was similar in PWH with and without NAFLD. (4) Conclusions: Implementing a two-tier pathway could save a substantial proportion up of TE examinations, reducing costs and helping resource optimization in HIV care. Patients with metabolic risk factors for NAFLD and low fibrosis biomarker may still be considered for TE referral. |
| first_indexed | 2024-03-09T21:37:21Z |
| format | Article |
| id | doaj.art-782ff9a369234fbf82d4401984a4f6fa |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T21:37:21Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-782ff9a369234fbf82d4401984a4f6fa2023-11-23T20:40:59ZengMDPI AGJournal of Personalized Medicine2075-44262022-02-0112228210.3390/jpm12020282Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected PatientsGiada Sebastiani0Jovana Milic1Adriana Cervo2Sahar Saeed3Thomas Krahn4Dana Kablawi5Al Shaima Al Hinai6Bertrand Lebouché7Philip Wong8Marc Deschenes9Claudia Gioè10Antonio Cascio11Giovanni Mazzola12Giovanni Guaraldi13Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaDepartment of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, ItalyChronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaDepartment of Internal Medicine—Infectious Disease, Center for Dissemination and Implementation, Institute for Public Health, School of Medicine, Washington University, St. Louis, MO 63110-1010, USAChronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaDivision of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaDivision of Experimental Medicine, McGill University, Montréal, QC H4A 3J1, CanadaChronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaDivision of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaDivision of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC H4A 3J1, CanadaInfectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone”, 90127 Palermo, ItalyInfectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone”, 90127 Palermo, ItalyInfectious Diseases Unit, S. Elia Hospital, 93100 Caltanissetta, ItalyDepartment of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy(1) Background: Developing strategies to identify significant liver fibrosis in people with HIV (PWH) is crucial to prevent complications of non-alcoholic fatty liver disease (NAFLD). We aim to investigate if five simple serum biomarkers applied to PWH can optimize a care pathway to identify significant liver fibrosis defined by transient elastography (TE). (2) Methods: A two-tier fibrosis pathway was applied to three prospective cohorts of PWH undergoing TE with CAP. NAFLD was diagnosed as a controlled attenuation parameter ≥ 248 dB/m. Five simple fibrosis biomarkers (FIB-4 < 1.3, BARD score 0–1, NAFLD fibrosis score < −1.455, AST:ALT ratio < 0.8 and APRI < 0.5) were applied as first-tiers to exclude significant liver fibrosis. We determined the decrease in referral for TE that would have occurred based on biomarker assessment and the discordance between low simple fibrosis biomarkers and high TE (≥7.1 kPa), indicating significant liver fibrosis. (3) Results: Of the 1749 consecutive PWH, 15.1% had significant liver fibrosis by TE and 39.1% had NAFLD. The application of the fibrosis biomarkers as first tiers would have resulted in a decrease in TE referrals between 24.9% (BARD score) and 86.3% (APRI). The lowest discordance rate was with NAFLD fibrosis score (8.5%). After adjustments, BMI (odds ratio (OR) 1.12, 95% CI: 1.08–1.17) and triglycerides (OR 1.26, 95% CI: 1.11–1.44) were independent predictors of discordance for APRI < 0.5 and TE ≥ 7.1. The performance of the two-tier pathways was similar in PWH with and without NAFLD. (4) Conclusions: Implementing a two-tier pathway could save a substantial proportion up of TE examinations, reducing costs and helping resource optimization in HIV care. Patients with metabolic risk factors for NAFLD and low fibrosis biomarker may still be considered for TE referral.https://www.mdpi.com/2075-4426/12/2/282transient elastographycontrolled attenuation parameterserum fibrosis biomarkersAPRIFIB-4 |
| spellingShingle | Giada Sebastiani Jovana Milic Adriana Cervo Sahar Saeed Thomas Krahn Dana Kablawi Al Shaima Al Hinai Bertrand Lebouché Philip Wong Marc Deschenes Claudia Gioè Antonio Cascio Giovanni Mazzola Giovanni Guaraldi Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients Journal of Personalized Medicine transient elastography controlled attenuation parameter serum fibrosis biomarkers APRI FIB-4 |
| title | Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients |
| title_full | Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients |
| title_fullStr | Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients |
| title_full_unstemmed | Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients |
| title_short | Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients |
| title_sort | two tier care pathways for liver fibrosis associated to non alcoholic fatty liver disease in hiv mono infected patients |
| topic | transient elastography controlled attenuation parameter serum fibrosis biomarkers APRI FIB-4 |
| url | https://www.mdpi.com/2075-4426/12/2/282 |
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