The Use of Ultrasonography, Transient Elastography, APRI and FIB-4 to Measure Liver Steatosis and Fibrosis in HIV-Positive Patients Not Co- Infected with Hepatitis Viruses with Hypertransaminasemia of Unknown Etiology on HAART

Background: HIV positive patients may be affected by hypertransaminasemia notwithstanding they are not co- infected with HCV and HBV. Aims: To understand the causes of this abnormality and what correlates are in terms of ultrasonic transient elastography (UTE) and ultrasonography (U) features and fibrosis scores. Methods: HIV positive patients with hypertransaminasemia have been studied. They underwent UTE and U. Non-invasive fibrosis scores (APRI and FIB-4) were calculated. Moreover, they underwent immunological and virological tests to exclude known causes of liver damage (including alcohol abuse). Results: Among 24 patients, 3 presented a progressive fibrosis at UTE. 3/3 with progressive fibrosis and further 14 patients among the entire sample had steatosis at U. Using non-invasive fibrosis scores, no patients had significant fibrosis, while 5 patients had mild fibrosis. 14 patients had hepatomegaly independently from steatosis. One patient has progressive fibrosis at UTE and mild fibrosis at both APRI and FIB-4, while 2 patients had fibrosis only at UTE, 2 only at APRI and 1 at both APRI and FIB-4, but not at UTE. Alcoholaemia was negative in all patients, confirming anamnestic information. No other causes of liver disease were found. Conclusions: In this series, more than 50% of patients had steatosis at U. Discordance between the non-invasive methods to estimate liver fibrosis were found. Further prospective studies are necessary to assess concordance between these methods and liver biopsy and assess the prognostic value of UTE, APRI and FIB-4 for liver complications in HIV mono- infected patients so as to improve diagnostic algorithms.