Systematic review and meta-analysis of the diagnostic accuracy of fibrosis marker panels in patients with HIV/hepatitis C coinfection


BACKGROUND: Accurately staging hepatitis C virus (HCV)-related fibrosis is crucial for treatment decisions and prognostication. Our objective was to systematically review studies describing the accuracy of serum marker panels for predicting fibrosis in HIV/HCV-coinfected patients. METHOD: Studies comparing serum marker panels with biopsy in HIV/HCV-coinfected patients were identified. Random effects meta-analyses and areas under summary receiver operating characteristics curves (AUC) examined test accuracy for detecting significant fibrosis (F2-4) and cirrhosis. Heterogeneity was explored using meta-regression. RESULTS: Five studies (n = 574) including four fibrosis measures (APRI [n = 4 studies], Forns’ [n = 2], FibroTest [n = 1], SHASTA [n = 1]) met the inclusion criteria. The prevalence of significant fibrosis and cirrhosis were 51% and 16%, respectively. For the prediction of significant fibrosis, the summary AUC was 0.82 (95% CI 0.78-86) and diagnostic odds ratio was 7.8 (5.1-11.9). For cirrhosis, these figures were 0.83 (0.69-0.97) and 11.0 (4.6-26.2), respectively. Meta-regression including study factors (methodological quality and biopsy adequacy), patient characteristics (age, gender, CD4 count), and fibrosis measure failed to identify important predictors of accuracy. CONCLUSION: Available fibrosis marker panels have acceptable performance for identifying significant fibrosis and cirrhosis in HIV/HCV-coinfected patients but are not yet adequate to replace liver biopsy. Additional studies are necessary to identify the optimal measure.


Shaheen AA, Myers RP.




  • Population(s)
    • General HIV+ population
  • Co-infections
    • Hepatitis B, C


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