Enhanced liver fibrosis marker as a non-invasive predictor of mortality in HIV/HCV-coinfected women from the women's Interagency HIV study

Objective: Coinfection with hepatitis C virus (HCV) is a major cause of morbidity and mortality among individuals with HIV. Our objective was to assess the prognostic performance of noninvasive measures of liver fibrosis in predicting all-cause mortality in women with HIV/HCV coinfection.Design: We studied HCV/HIV coinfected women enrolled in the prospective, multicenter Women's Interagency HIV Study. Aspartate aminotransferase to platelet ratio and FIB-4 were used to identify women without fibrosis at all visits and women who progressed to severe fibrosis.Methods: Enhanced liver fibrosis (ELF), which utilizes direct measures of fibrosis, hyaluronic acid, procollagen III aminoterminal peptide and tissue inhibitor of matrix metalloproteinase was performed.Results: Included were 381 women with 2296 ELF measurements, with mean follow-up 8.3?±?3.3 years. There were 134 deaths (60% with severe liver fibrosis). Receiver operator characteristic curves at fixed time windows prior to death or at end of follow-up showed that ELF was best at predicting mortality when tested within a year of death (area under the curve for ELF 0.85 vs. APRI 0.69, P?<?0.0001 and vs. FIB-4 0.75, P?=?0.0036); and 1–3 years prior (ELF 0.71 vs. APRI 0.61, P?=?0.005 and vs. FIB-4 0.65, P?=?0.06). Use of all three measures did not improve on ELF alone. In multivariate logistic regression models controlling for CD4+ cell count, HIV viral load, antiretroviral use and age, ELF continued to perform better than APRI and FIB-4.Conclusion: ELF predicted all-cause mortality and was superior to APRI and FIB-4 in HIV/HCV coinfected women.