gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Transient elastometry (Fibroscan®) appears not to be applicable in HIV monoinfected patients with elevated liver function tests

Transiente Elastometrie mittels Fibroscan® scheint bei HIV-monoinfizierten Patienten mit erhöhten Leberwerten nicht anwendbar zu sein

Meeting Abstract

  • H. Keim - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • M. Berger - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • J. Hartikainen - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • U. Joppek - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • J. Kirchberg - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • M.K. Mausolf - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • H. Stocker - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • C. Weber - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • K. Arastéh - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany
  • R. Weiss - Hämatologie/Infektiologie, Bremen, Germany
  • P. Ingiliz - Vivantes Auguste Viktoria Klinikum, Gastroenterologie und Infektiologie, Berlin, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP59

DOI: 10.3205/10kit115, URN: urn:nbn:de:0183-10kit1154

Veröffentlicht: 2. Juni 2010

© 2010 Keim et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Elevated liver function tests (eLFT) in HIV monoinfected patients (pts) have been previously reported, caused by several medical conditions such as hepatic steatosis, non-alcoholic steatohepatitis (NASH), nodular regenerative hyperplasia or drug toxicity. These conditions may lead to liver fibrosis and, consecutively, to end-stage liver disease or portal hypertension. The best method to stage liver disease in those pts has not yet been established.

Methods: We performed transient elastometry (Fibroscan®), liver biopsy, and laboratory analysis in HIV- and HCV infected pts as well as in pts with HIV/HCV coinfection seen in our outpatient liver unit. Fibroscan results over 7kPa were considered as significant fibrosis (Metavir F2-F4).

Results: 31 pts were included (mean age 45years, range 29-63, 24 male, 8 female, HCV n=12, HIV/HCV n=11, HIV n=8). The three groups (HCV, HIV/HCV, HIV) were comparable with regard to age, HIV and HCV viral load and standard laboratory markers. The predominant HCV genotype was 1 (89%). BMI was higher in HCV infected pts (25, 22 and 20 kg/m2, respectively). LIver biopsy size was 22, 21 and 15mm, respectively. The percentage of pts with significant hepatic steatosis (more than 10%) was 33%, 22% and 38%, respectively.

Fibroscan® showed consistently higher results compared to liver biopsy in HIV monoinfected pts. Assessment of significant fibrosis by transient elastometry was concordant with the liver biopsy in only 25% of cases in this group, while being 73% for HCV infected pts and 45% for HCV/HIV coinfected pts.

No difference was found for markers of insulin resistance or inflammation, such as interleukin-6, d-dimers or CRP between the three groups.

APRI score was significantly higher in the HIV monoinfected group (1.35, 0.98, and 1.64, respectively).

Conclusion: Elevated liver function tests in HIV monoinfected patients are caused by several reasons. Classical methods to assess the stage of liver disease do not seem to be applicable for this group of patients.

Our ongoing clinical database showed a trend that HIV monoinfected patients with elevated LFTs may be falsly overestimated by non-invasive fibrosis assessment with Fibroscan® or APRI score. Further studies will be needed to identify possible causes of this phenomenon which might help to alterate the established algorithms in order to apply to this group of pts.