Comparison of FIB-4 and APRI in HIV-HCV coinfected patients with normal and elevated ALT

Dig Dis Sci. 2011 Oct;56(10):3038-44. doi: 10.1007/s10620-011-1710-2. Epub 2011 Apr 28.


Background and aims: Liver biopsy is standard for assessment of disease severity in patients with chronic HCV. However, associated risks have led to the development of simple non-invasive models. However, their utility in those with normal ALT is unknown.

Methods: FIB-4 and APRI were calculated for patients with HIV-HCV coinfection undergoing biopsy. The performance of each model and AUROC for predicting significant fibrosis (Ishak 4-6) were determined for the entire cohort and stratified by elevated (≥60 U/l in men and ≥40 U/l in women) and normal ALT.

Results: Two-hundred and ninety-five liver biopsies from 237 patients were included. Elevated ALT was observed in 55, and 15% had significant fibrosis. The AUROC curve for patients with elevated ALT was 0.8 for FIB-4 and 0.76 for APRI, compared with 0.90 for the FIB-4 and 0.85-0.95 for the APRI in those with normal ALT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FIB-4 were 1.0, 0.91, 0.50, and 1.0 for patients with normal ALT; the values were 0.67, 0.99, 0.67, and 0.99 for APRI.

Conclusions: Both FIB-4 and APRI are useful for highly accurate identification of those without advanced fibrosis. However, because they have poor positive predictive value, liver biopsy will continue to be used for assessment of patients with coinfection.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Alanine Transaminase / blood*
  • Aspartate Aminotransferases / blood*
  • Biomarkers / blood
  • Biopsy
  • Comorbidity
  • Female
  • HIV Infections / blood*
  • HIV Infections / epidemiology
  • HIV Infections / pathology*
  • Hepatitis C / blood*
  • Hepatitis C / epidemiology
  • Hepatitis C / pathology*
  • Humans
  • Liver / pathology
  • Liver Cirrhosis / pathology*
  • Liver Function Tests
  • Male
  • Middle Aged
  • Platelet Count
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Severity of Illness Index


  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase