Performance of 11 biomarkers for liver fibrosis assessment in HIV/HBV co-infected patients

Background/Aims: The aim of this study was to compare the performance of 11 biochemical scores to estimate liver fibrosis in HIV/HBV co-infection. Methods: Performance was evaluated using the Receiver Operating Characteristics (ROC) curve method. The Kappa index was used to study overall agreement with liver biopsy results. Interpretative algorithms were established by optimizing sensitivity and specificity and the percentage of correctly classified patients. Results: One hundred and eight patients (F0-F1, n = 47; F2, n = 28; F3, n = 17; F4, n = 16) were considered for the evaluation of serum biomarker performance. The AUROCs of the Fibrotest (R), Hepascore (R), Fibrometer (R) and Zeng's scores ranged from 0.74 to 0.77 for significant fibrosis (>= F2), from 0.79 to 0.84 for advanced fibrosis (>= F3) and from 0.87 to 0.92 for cirrhosis (F4). Thresholds defined for each stage of fibrosis were close to those previously published for the Fibrotest (R) and Hepascore (R). Strict concordance with biopsies correctly classified 50% of the patients. Conclusions: Fibrotest (R), Fibrometer (R), Hepascore (R), and Zeng's score were the most accurate non-invasive biochemical scores for liver fibrosis assessment in HIV/HBV co-infection. Global performance of biomarkers was not significantly improved by a decision tree combining the results of two biochemical scores. Crown copyright (C) 2009 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.