Evaluation of FIB-4 Index as a Marker for Hepatocellular Carcinoma in HIV - Hepatitis C Co-Infection

Abstract

Background: Chronic co-infection with hepatitis C (HCV) and HIV leads to progressive liver fibrosis and increases the risk for hepatocellular carcinoma (HCC), creating the need for cancer surveillance. However, screening methods for HCC are controversial. We evaluated Fibrosis-4 (FIB-4); an index calculated from platelet count, alanine aminotransferase, aspartate aminotransferase and age; as a screening tool for HCC in patients with HIV-HCV coinfection. Methods: This was a retrospective chart review of adult outpatients followed at our HIV clinic for the period 2008- 2014, including 11 patients with HIV-HCV co-infection and HCC. Age- and sex-matched control groups were selected, including patients with co-infection without cirrhosis or HCC, HIV mono-infection; and patients with co-infection and cirrhosis without HCC. Mean FIB-4 indices were calculated for each group for comparison. Results: The mean patient age was 55 years. Median CD4+ counts for the groups ranged from 413 to 552 /μL (p>0.05). The mean FIB-4 was not significantly different between patients with HIV (1.66 ± 0.93), compared to patients with HIV-HCV (2.11 ± 0.82). Mean FIB-4 score was significantly higher in patients with co-infection and cirrhosis (6.5 ± 5.1) compared to patients with co-infection without cirrhosis (2.11 ± 0.82; p=0.011). The mean FIB-4 score was higher for patients with co-infection and HCC, compared to patients with co-infection (p=0.009), or HIV only (p=0.004) without cancer. Mean FIB-4 score was not significantly different between patients with co-infection and cancer, and patients with co-infection and cirrhosis without cancer (5.87 ± 4.22 and 6.5 ± 5.1 respectively). Conclusion: FIB-4 appears to be a marker of cirrhosis but not specifically HCC in chronic HIV-HCV co-infection. FIB-4 can be a cost-effective strategy to identify patients with HIV and HCV who have advanced cirrhosis, and thereby are at increased risk for development of HCC.