1677. FIB-4: An Inexpensive Marker of Hepatocellular Carcinoma in Patients with HIV and Hepatitis C Co-infection
Session: Poster Abstract Session: HIV: HIV/HCV Co-Infection Treatment and Complications
Saturday, October 10, 2015
Room: Poster Hall
  • IDSA poster 2.png (394.9 kB)
  • Background:

    Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) infections increase the risk for developing hepatocellular carcinoma (HCC). However, screening methods for HCC are controversial. Therefore we evaluated the utility of Fibrosis-4 (FIB-4); an index calculated from platelet count (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and age {Age [yr] × AST [U/L]} / {PLT [109/L] × ALT 1/2[U/L] }; as a screening tool for HCC in patients with HIV-HCV co-infections at the Infectious Diseases Practice at University Hospital, Newark, NJ. 


    We conducted an IRB-approved chart review of 11 patients with HIV-HCV co-infection and HCC (Group A) from 2008 to 2014, and an equal number of age and sex matched controls with HIV-HCV co-infection without HCC (Group B) and HIV mono-infection (Group C). Data collected included demographics, AST and ALT levels, platelet count, CD4 count, HIV viral load, hepatitis B status, and presence of cirrhosis (at the time of HCC diagnosis, otherwise most recent results). Mean FIB-4 indices were calculated for each group (at the time of HCC diagnosis for Group A and most recent values available for Groups B and C) and compared for significant differences by analysis-of-variance with SPSS software. 


    The mean patient age was 55 years, 45% were male. All patients were African-American. The median CD4 counts (per μL) were 485, 409 and 413 for Groups A, B, and C respectively (p=NS). Nine of the eleven patients with HCC had cirrhosis previously diagnosed through CT scan.  73% of the HCC cases were localized at the time of diagnosis and treated with chemoablation. The mean FIB-4 score for Groups A, B and C was 5.87 (± 4.22), 2.11 (± 0.82), and 1.66 (± 0.93) respectively. Mean FIB-4 score was significantly higher for Group A compared to Group B (p=0.009), and Group C (p=0.004). 


    This preliminary study shows FIB-4 index can be a cost-effective and safe marker of HCC in patients at its highest risk; and thereby limit expensive studies such as computerized tomography for HCC screening in this select high-risk group of patients. We plan to do additional studies to understand the implications of these results and also to assess the impact of cirrhosis on the FIB-4 index in this population.

    Sobia Nizami, MD1, Jason Zucker, MD2 and Shobha Swaminathan, MD1, (1)Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, (2)Medicine and Pediatrics, Rutgers New Jersey Medical School, Newark, NJ


    S. Nizami, None

    J. Zucker, None

    S. Swaminathan, None

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