Prevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth.

TitlePrevalence of and progression to abnormal noninvasive markers of liver disease (aspartate aminotransferase-to-platelet ratio index and Fibrosis-4) among US HIV-infected youth.
Publication TypePublication
Year of Publication2016
AuthorsKapogiannis BG, Leister E, Siberry GK, Van Dyke RB, Rudy B, Flynn P, Williams PL
Corporate AuthorsREACH Study and the PACTG 219219C Study
JournalAIDS
Volume30
Issue6
Pagination889-98
Date Published2016 Mar 27
ISSN1473-5571
KeywordsAdolescent, Aspartate Aminotransferases, Child, Disease Progression, Female, HIV Infections, Humans, Liver Diseases, Longitudinal Studies, Male, Platelet Count, Prevalence, Prospective Studies, United States, Young Adult
Abstract

<p><b>OBJECTIVE: </b>To longitudinally characterize noninvasive markers of liver disease in HIV-infected youth.</p><p><b>DESIGN: </b>HIV infection, without viral hepatitis coinfection, may contribute to liver disease. Noninvasive markers of liver disease [FIB-4 (Fibrosis-4) and APRI (aspartate aminotransferase-to-platelet ratio index)] have been evaluated in adults with concomitant HIV and hepatitis C, but are less studied in children.</p><p><b>METHODS: </b>In prospective cohorts of HIV-infected and HIV-uninfected youth, we used linear regression models to compare log-transformed FIB-4 and APRI measures by HIV status based on a single visit at ages 15-20 years. We also longitudinally modeled trends in these measures in HIV-infected youth with two or more visits to compare those with behavioral vs. perinatal HIV infection (PHIV) using mixed effect linear regression, adjusting for age, sex, body mass index, and race/ethnicity.</p><p><b>RESULTS: </b>Of 1785 participants, 41% were men, 57% black non-Hispanic, and 27% Hispanic. More HIV-infected than uninfected youth had an APRI score more than 0.5 (13 vs. 3%, P < 0.001). Among 1307 HIV-infected participants with longitudinal measures, FIB-4 scores increased 6% per year (P < 0.001) among all HIV-infected youth, whereas APRI scores increased 2% per year (P = 0.007) only among PHIV youth. The incidence rates (95% confidence interval) of progression of APRI to more than 0.5 and more than 1.5 were 7.5 (6.5-8.7) and 1.4 (1.0-1.9) cases per 100 person-years of follow-up, respectively. The incidence of progression of FIB-4 to more than 1.5 and more than 3.25 were 1.6 (1.2-2.2) and 0.3 (0.2-0.6) cases per 100 person-years, respectively.</p><p><b>CONCLUSION: </b>APRI and FIB-4 scores were higher among HIV-infected youth. Progression to scores suggesting subclinical fibrosis or worse was common.</p>

DOI10.1097/QAD.0000000000001003
Alternate JournalAIDS
PubMed ID26959353
PubMed Central IDPMC4785818
Grant ListU01 HD052104 / HD / NICHD NIH HHS / United States
U01HD052102 / HD / NICHD NIH HHS / United States
U01 HD040533 / HD / NICHD NIH HHS / United States
HHSN267200800001G / DK / NIDDK NIH HHS / United States
U01 HD032842 / HD / NICHD NIH HHS / United States
HD052102 / HD / NICHD NIH HHS / United States
U01 AI068632 / AI / NIAID NIH HHS / United States
UM1 AI068632 / AI / NIAID NIH HHS / United States
U01 AI068616 / AI / NIAID NIH HHS / United States
HHSN267200800001C / HD / NICHD NIH HHS / United States
U01 AI041110 / AI / NIAID NIH HHS / United States
U01HD052104 / HD / NICHD NIH HHS / United States
N01-HD33345 / HD / NICHD NIH HHS / United States
UM1 AI068616 / AI / NIAID NIH HHS / United States
N01-DK-9-001/HHSN267200800001C / DK / NIDDK NIH HHS / United States
U01 HD052102 / HD / NICHD NIH HHS / United States
U01AI068632 / AI / NIAID NIH HHS / United States
HHSN267200800001C / / PHS HHS / United States
U01HD32842 / HD / NICHD NIH HHS / United States
1 U01 AI068616 / AI / NIAID NIH HHS / United States
5 U01 AI41110 / AI / NIAID NIH HHS / United States
U01AI41110 / AI / NIAID NIH HHS / United States
HD052104 / HD / NICHD NIH HHS / United States
Z99 HD999999 / NULL / Intramural NIH HHS / United States