Use of Non-invasive Testing to Stage Liver Fibrosis in Patients with HIV

Curr HIV/AIDS Rep. 2016 Oct;13(5):279-88. doi: 10.1007/s11904-016-0329-5.


Patients with HIV have a proclivity to develop liver fibrosis, especially when associated with other conditions such as HCV, HBV, and NAFLD. Identifying HIV-infected patients with significant fibrosis or cirrhosis plays an important role in clinical and therapeutic decision-making. Liver biopsy is currently considered as the gold standard for fibrosis assessment but carries many shortcomings (cost, invasiveness, complications, false negative rate of 20 %). Multiple non-invasive methods of liver fibrosis assessment have been developed, but not all have been studied in HIV-infected individuals. Non-invasive liver fibrosis tools include both serologic-based testing scores (rely on direct and/or indirect markers) such as APRI, FIB4, FibroTest, FibroSpect II, HepaScore, or imaging-based methods such as vibration controlled liver elastography. There is validated data to support the use of non-invasive modalities of fibrosis assessment in HIV-HCV co-infected individuals for the exclusion of cirrhosis, but may be poorly reliable or not enough data exists for the assessment of other co-morbid disease processes.

Keywords: Biomarkers; HIV non-alcoholic fatty liver disease; HIV-hepatitis B; HIV-hepatitis C; Liver fibrosis; Transient elastography.

Publication types

  • Review

MeSH terms

  • Biomarkers / blood
  • Biopsy
  • Coinfection
  • Elasticity Imaging Techniques / methods*
  • HIV Infections / complications*
  • HIV Infections / pathology
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / pathology
  • Humans
  • Liver / pathology*
  • Liver / virology
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / pathology


  • Biomarkers