Use of Transient Elastography in Patients with HIV-HCV Co-infection: A Systematic Review and Meta-analysis

2016 Journal of Gastroenterology & Hepatology In press;

BACKGROUND: Patients with HIV-HCV co-infection progress towards liver fibrosis and cirrhosis more rapidly compared to HCV mono-infected individuals. This necessitates an accurate assessment of liver stiffness with transient elastography to guide treatment. METHODS: Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were performed through January 2016 to assess the diagnostic accuracy of transient elastography for liver stiffness in the HIV-HCV population. Included studies were analyzed according to the Cochrane DTA Working Group methodology. Bivariate and hierarchical models were used to compute pooled sensitivity and specificity. Positive and negative likelihood ratios (LRs) were also determined. A Fagan nomogram was constructed. Meta-regression analysis was performed with assessment of publication bias using Deeks' funnel plot asymmetry testing. RESULTS: A total of 6 studies (n = 756) met inclusion criteria. The diagnostic accuracy of elastography for the diagnosis of moderate (>/=F2) fibrosis was 88% (95% CI, 0.85-0.90). The pooled sensitivity and specificity of moderate fibrosis was 97% (95% CI, 0.82-0.91) and 64% (95% CI, 0.45-0.79), respectively. The diagnostic accuracy of elastography for the assessment of cirrhosis was 94% (95% CI, 0.91-0.95). The pooled sensitivity and specificity for cirrhosis was 90% (95% CI, 0.74-0.97) and 87% (95% CI, 0.80-0.92), respectively. Meta-regression analysis demonstrated that CD4 cell count did not impact diagnostic accuracy of elastography. CONCLUSION: Transient elastography is a non-invasive imaging modality with excellent ability to assess for cirrhosis in patients with HIV-HCV co-infection. This article is protected by copyright. All rights reserved.

Pubmed : 26952020