Current and Investigational Biomarkers of Liver Disease in HIV-HBV Co-infection.

PURPOSE OF REVIEW: Coinfection with HIV-HBV results in increased rate of liver disease progression through immune and metabolic dysfunction. Additional metabolic risks in ageing people with HIV (PwHIV) contribute to hepatic necroinflammation and fibrogenesis. There are now several blood-based and imaging non-invasive tests (NIT) that are increasingly available as an alternative to biopsy to estimate hepatic fibrosis. RECENT FINDINGS: There are few studies for NITs and fibrosis in PwHIV-HBV. Simple tests such as FIB-4 and APRI have poor diagnostic utility for significant fibrosis or disease monitoring in PwHIV-HBV. Transient elastography (TE) has less variability, and may be useful to exclude advanced fibrosis in patients with low viral load and normal liver enzymes. Combination TE and blood-based NITs with concordant results may be useful, but optimal diagnostic test thresholds have not been established. Interpretation of current NITs in PwHIV-HBV should consider context of use, along with clinical and biochemical variables that limit diagnostic accuracy.

Duke Scholars

Author Keyur Patel Medicine, Gastroenterology