What People Living with HIV and Liver Disease Need to Know about Diagnostic Tests

A summary of Diagnostic Ability of Simple Noninvasive Blood Tests to Predict Increased Liver Stiffness in People Living With HIV and Steatotic Liver Disease, published in the American Journal of Gastroenterology.

Why It's Important to Check for Advanced Liver Disease in People with HIV

People with HIV often have a liver problem called steatotic liver disease, which is when fat builds up in the liver, or “fatty liver.” Finding out if this has turned into a more serious condition, called advanced fibrosis, is really important. Advanced fibrosis means the liver has a lot of scar tissue and might not work well. Steatotic liver disease is now the leading indication for liver transplant and associated with developing liver cancer.

Researchers who are part of the HIV NASH Clinical Research Network, led by Richard Sterling, M.D., M.Sc., chief of hepatology and the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health’s chief clinical officer at Virginia Commonwealth University, wanted to see how well two simple tests, FIB-4 and the NAFLD Fibrosis Score (NFS), work to find advanced fibrosis in people with HIV.

Why This Matters

People with HIV can have liver problems for many reasons, including viral hepatitis, alcohol excess, and metabolic diseases such as type 2 diabetes and obesity. If we can find advanced liver problems early, doctors can treat them better and stop them from getting worse.

How the Study Was Done

The study looked at adults with HIV without viral hepatitis who were taking their HIV medicine and had controlled HIV. They didn’t include people with other liver diseases, heavy drinkers, or those with obvious severe liver damage. They used a special test to measure how stiff the liver was, which helps to know if there is a lot of scar tissue.

What the Study Found

The study included 1,065 people with an average age of about 52 years. Most were men and many were overweight or had other health problems like high cholesterol, diabetes, and high blood pressure; the risks for metabolic-dysfunction associated steatotic liver disease.

• The average measurement of stiffness was 6.3 kPa, and 6.3% of people had advanced fibrosis.
• Both FIB-4 and NFS tests were good at ruling out advanced fibrosis. If someone’s test was negative, it was very unlikely they had advanced fibrosis.
• FIB-4 was 64% sensitive (correctly finding those with advanced fibrosis) and 97% specific (correctly finding those without advanced fibrosis).
• NFS was 80% sensitive and 96% specific.

What This Means

The FIB-4 and NFS tests are good for checking if people with HIV don’t have advanced fibrosis. If these tests show no advanced fibrosis, most people don’t need more tests or to see a liver specialist. This helps doctors focus on those who really need more care.

Conclusion

People with HIV should have regular checks for liver problems. Simple indices like FIB-4 and NFS, which can be calculated from routine blood test, can help doctors find out who needs more tests and who doesn’t. This helps in treating liver problems early and keeps people with HIV healthier.