Prediction of hepatic fibrosis in HIV/HCV co-infected patients using serum fibrosis markers: the SHASTA index

J Hepatol. 2005 Jul;43(1):78-84. doi: 10.1016/j.jhep.2005.02.025. Epub 2005 Apr 25.


Background/aims: To examine if serum fibrosis biomarkers could accurately identify the stage of liver disease amongst hepatitis C (HCV) and HIV co-infected patients.

Methods: One hundred and thirty seven HIV/HCV co-infected persons were randomly selected from the Johns Hopkins HIV Clinic cohort. Ninety five had complete testing for fibrosis markers in sera collected at the time of liver biopsy. Biopsies were scored according to Ishak modified histological activity index (F0 no fibrosis to F6 cirrhosis). Fibrosis was evaluated against alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST to platelet ratio (APRI), albumin, total bilirubin, hyaluronic acid (HA) and YKL-40.

Results: Sixty nine (73%) had no or minimal portal fibrosis (F0-2) and were compared with remaining subjects (F3-6). Fibrosis scores > or =F3 were found 27 times more often in persons with HA levels >86 ng/ml and 5.5 times more often in persons with HA levels 41-86 ng/ml. Less substantial associations were detected with levels of albumin <3.5 g/dl (OR 4.85) and AST >60 iu (OR 5.91). All 35 subjects who had favorable results of HA, albumin, and AST had minimal fibrosis (F0-2).

Conclusions: Amongst HIV/HCV co-infected patients, serum testing for HA, albumin, and AST (SHASTA Index) was able to accurately stage mild and advanced fibrosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aspartate Aminotransferases / blood
  • Biomarkers / blood*
  • Disease Progression
  • Female
  • HIV Infections / complications*
  • Hepatitis C / complications*
  • Humans
  • Hyaluronic Acid / blood
  • Liver / pathology
  • Liver Cirrhosis / metabolism*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Sensitivity and Specificity
  • Serum Albumin / metabolism
  • Severity of Illness Index


  • Biomarkers
  • Serum Albumin
  • Hyaluronic Acid
  • Aspartate Aminotransferases