Proficiency of transient elastography compared to liver biopsy for the assessment of fibrosis in HIV/HBV‐coinfected patients

Summary.  Transient elastography (TE) is a noninvasive technique to evaluate liver fibrosis. We compared the performance of TE with liver biopsy (LB) in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection. Patients prospectively underwent TE and LB. The diagnosis accuracy of TE was calculated using receiver operating characteristic (ROC) curves for different stages of fibrosis, and optimal cut‐off values were defined. A sequential algorithm combining TE with biochemical score (Fibrotest®) is proposed. Fifty‐seven patients had both TE and LB (median time: 3 days) and two with proven cirrhosis, only TE. Forty‐six (78%) were under antiretroviral therapy with anti‐HBV drugs in 98%, and 19 (32%) had elevated alanine aminotransferase (ALT). A significant correlation was observed between liver stiffness measurement (LSM) and METAVIR fibrosis stages (P < 0.0001). Patients with elevated ALT tended to have higher LSM than those with normal ALT. The areas under the ROC curves were 0.85 for significant fibrosis (≥F2), 0.92 for advanced fibrosis (≥F3) and 0.96 for cirrhosis. Using a cut‐off of 5.9 kPa for F≥2 and 7.6 kPa for F ≥ 3, the diagnosis accuracy was 83% and 86%, respectively. With an algorithm combining TE and Fibrotest®, 97% of patients were well classified for significant fibrosis. Using this algorithm, the need for LB can be reduced by 67%. In HIV/HBV‐coinfected patients, most of them with normal ALT under antiretroviral treatment including HBV active drugs, TE was proficient in discriminating moderate to severe fibrosis from minimal liver disease.