Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients
Abstract
:1. Introduction
2. Materials and Methods
- -
- -
- AST-to-Platelet Ratio Index (APRI) = (AST/upper limit of normal)/platelets × 100. A cut-off < 0.5 was used to exclude significant liver fibrosis [36].
- -
- -
- BARD = BMI ≥ 28 kg/m2 (yes = 1, no = 0) + AST:ALT ratio ≥ 0.8 (yes = 2, no = 0) + type-2 diabetes (yes = 1, no = 0). A cut-off < 2 was used to exclude significant liver fibrosis [38].
- -
- NAFLD fibrosis score = −1.675 + (0.037 × age) + (0.094 × BMI) + (1.13 × diabetes (yes = 1, no = 0)) + (0.99 × AST:ALT ratio) − (0.013 × platelets) − (0.66 × albumin (g/dL)). A cut off < −1.455 was used to exclude significant liver fibrosis [39].
3. Results
3.1. Application of the Two-Tier Pathway
3.2. Effect of NAFLD
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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LSM ≥ 7.1 kPa (n = 264) | LSM < 7.1 kPa (n = 1485) | p | |
---|---|---|---|
Age (years) | 53.1 (9.4) | 49.7 (10.5) | <0.001 |
Male sex (%) | 203 (76.9) | 1100 (74.1) | 0.333 |
Ethnicity (%) | |||
White/Caucasian | 231 (87.5) | 1250 (84.2) | 0.167 |
Black non-Hispanic | 25 (9.5) | 168 (11.3) | |
Diabetes (%) | 110 (41.7) | 484 (32.6) | <0.001 |
BMI (Kg/m2) ° | 27.2 (5.3) | 24.7 (4.0) | <0.001 |
Time since HIV diagnosis (years) | 18.9 (10.3) | 14.9 (9.6) | <0.001 |
Undetectable HIV viral load (<40 copies/mL) (%) | 203 (77.0) | 1099 (74.0) | 0.322 |
CD4 cell count (cells/μL) | 669.3 (347.4) | 708.9 (312.6) | 0.065 |
Current ART regimen (%) | |||
NRTIs | 228 (86.4) | 1268 (85.4) | 0.678 |
NNRTIs | 122 (46.2) | 649 (43.7) | 0.449 |
Protease inhibitors | 148 (56.1) | 768 (51.7) | 0.192 |
Integrase inhibitors | 83 (31.4) | 538 (36.2) | 0.134 |
Past exposure to didanosine (%) | 23 (8.7) | 107 (7.2) | 0.390 |
ALT (IU/L) | 35.5 (32.3) | 24.5 (16.1) | <0.001 |
AST (IU/L) | 31.7 (24.2) | 23.1 (10.4) | <0.001 |
Platelets (109 cells/L) | 202.3 (74.3) | 223.8 (62.3) | <0.001 |
Albumin (g/dL) | 4.32 (0.55) | 4.37 (0.40) | 0.119 |
Triglycerides (mmol/L) | 1.96 (1.76) | 1.51 (1.06) | <0.001 |
Total cholesterol (mmol/L) | 3.58 (1.89) | 2.97 (2.23) | <0.001 |
HDL (mmol/L) | 1.18 (0.38) | 1.28 (0.39) | <0.001 |
CAP (dB/m) | 269.2 (61.7) | 230.8 (54.2) | <0.001 |
AST: ALT ratio | 1.07 (0.65) | 1.09 (0.44) | 0.375 |
BARD score | 2.20 (1.14) | 2.01 (1.11) | 0.015 |
NAFLD fibrosis score | −0.84 (1.55) | −1.70 (1.36) | <0.001 |
FIB-4 | 1.91 (2.00) | 1.20 (0.67) | <0.001 |
APRI | 0.60 (0.82) | 0.33 (0.20) | <0.001 |
APRI | FIB-4 | NAFLD Fibrosis Score | BARD Score | AST: ALT Ratio | |
---|---|---|---|---|---|
Decrease in TE referral (%) | 86.3 | 63.0 | 51.2 | 24.9 | 26.2 |
Discordance high LSM/ low biomarker (%) | 11.7 | 11.0 | 8.5 | 15.4 | 19.5 |
Direct cost of serum biomarker per 100 PWH (CAD) | 1700 | 1700 | 2200 | 1000 | 1000 |
TE cost saved per 100 PWH (CAD) | 10,788 | 7875 | 6400 | 3113 | 3275 |
Total direct cost saved per 100 PWH (CAD) | 9088 | 6175 | 4200 | 2113 | 2275 |
Variable | OR (95% CI) | aOR (95% CI) | p-Value |
---|---|---|---|
FIB-4 | |||
Male sex (yes vs. no) | 0.91 (0.60–1.39) | 0.82 (0.51–1.31) | 0.052 |
BMI (per Kg/m2) | 1.14 (1.09–1.19) | 1.14 (1.09–1.19) | <0.001 |
Diabetes (yes vs. no) | 0.83 (0.56–1.28) | 0.77 (0.48–1.23) | 0.270 |
Triglycerides (per mmol/L) | 1.29 (1.11–1.49) | 1.23 (1.03–1.45) | 0.019 |
CD4 cell count (per 100 cell/mL) | 0.99 (0.99–1.00) | 0.99 (0.99–1.00) | 0.807 |
APRI | |||
Age (per 10 years) | 1.27 (1.09–1.48) | 1.19 (0.99–1.42) | 0.054 |
Male sex (yes vs. no) | 0.95 (0.67–1.35) | 0.74 (0.50–1.09) | 0.129 |
BMI (per Kg/m2) | 1.12 (1.08–1.16) | 1.12 (1.08–1.17) | <0.001 |
Diabetes (yes vs. no) | 1.21 (0.87–1.68) | 1.13 (0.78–1.64) | 0.511 |
Triglycerides (per mmol/L) | 1.32 (1.17–1.48) | 1.26 (1.11–1.44) | 0.001 |
CD4 cell count (per 100 cell/mL) | 0.99 (0.99–1.00) | 0.99 (0.99–1.00) | 0.154 |
CAP ≥248 dB/m (n = 166) | CAP <248 dB/m (n = 98) | p-Value | |
---|---|---|---|
Age (years) | 53.6 (8.9) | 52.3 (10.2) | 0.293 |
Male sex (%) | 135 (81.3) | 68 (69.4) | 0.026 |
Ethnicity (%) | |||
White/Caucasian | 139 (83.7) | 92 (93.9) | 0.581 |
Black non-Hispanic | 17 (10.2) | 8 (8.2) | |
Diabetes (%) | 66 (60.0) | 44 (40.0) | 0.413 |
BMI (Kg/m2) ° | 28.7 (4.7) | 24.4 (5.2) | <0.001 |
Time since HIV diagnosis (years) | 18.5 (9.7) | 19.5 (11.3) | 0.435 |
Undetectable HIV viral load (<40 copies/mL) (%) | 125 (75.3) | 78 (79.6) | 0.639 |
CD4 cell count (cells/μL) | 711.3 (656.8) | 599.3 (330.7) | 0.012 |
Current ART regimen (%) | |||
NRTIs | 141 (84.9) | 87 (88.8) | 0.380 |
NNRTIs | 80 (48.3) | 42 (43.9) | 0.401 |
Protease inhibitors | 101 (60.8) | 62 (63.3) | 0.696 |
Integrase inhibitors | 48 (28.9) | 35 (35.7) | 0.250 |
Past exposure to didanosine (%) | 6 (3.6) | 17 (17.3) | <0.001 |
ALT (IU/L) | 38.0 (34.9) | 31.3 (27.0) | 0.105 |
AST (IU/L) | 30.7 (23.7) | 33.3 (24.9) | 0.410 |
Platelets (109 cells/L) | 214.2 (68.9) | 182.1 (78.9) | <0.001 |
Albumin (g/L) | 43.5 (5.4) | 42.6 (5.7) | 0.233 |
Triglycerides (mmol/L) | 2.3 (2.1) | 1.4 (0.8) | <0.001 |
Total cholesterol (mmol/L) | 4.6 (1.1) | 1.9 (1.7) | <0.001 |
HDL (mmol/L) | 1.1 (0.4) | 1.3 (0.4) | 0.012 |
AST:ALT ratio | 0.93 (0.34) | 1.29 (0.93) | <0.001 |
BARD score | 2.19 (1.14) | 2.22 (1.14) | 0.818 |
NAFLD fibrosis score | −0.95 (1.41) | −0.66 (1.75) | 0.247 |
FIB-4 | 1.50 (1.11) | 2.61 (2.83) | <0.001 |
APRI | 0.50 (0.61) | 0.77 (1.07) | 0.008 |
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Sebastiani, G.; Milic, J.; Cervo, A.; Saeed, S.; Krahn, T.; Kablawi, D.; Al Hinai, A.S.; Lebouché, B.; Wong, P.; Deschenes, M.; Gioè, C.; Cascio, A.; Mazzola, G.; Guaraldi, G. Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients. J. Pers. Med. 2022, 12, 282. https://doi.org/10.3390/jpm12020282
Sebastiani G, Milic J, Cervo A, Saeed S, Krahn T, Kablawi D, Al Hinai AS, Lebouché B, Wong P, Deschenes M, Gioè C, Cascio A, Mazzola G, Guaraldi G. Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients. Journal of Personalized Medicine. 2022; 12(2):282. https://doi.org/10.3390/jpm12020282
Chicago/Turabian StyleSebastiani, Giada, Jovana Milic, Adriana Cervo, Sahar Saeed, Thomas Krahn, Dana Kablawi, Al Shaima Al Hinai, Bertrand Lebouché, Philip Wong, Marc Deschenes, Claudia Gioè, Antonio Cascio, Giovanni Mazzola, and Giovanni Guaraldi. 2022. "Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients" Journal of Personalized Medicine 12, no. 2: 282. https://doi.org/10.3390/jpm12020282