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

Ilaria Izzo, Luciano Biasi, Monia Mendeni, Katiela Prestini, Andrea Vavassori, Emanuele Foca, Eugenia Quiros-Roldan, Giampiero Carosi, Carlo Torti*
Institute of Infectious and Tropical Diseases, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.

© 2011 Izzo et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: * Address correspondence to this author at the Institute of Infectious and Tropical Diseases, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. E-mail:



HIV positive patients may be affected by hypertransaminasemia notwithstanding they are not coinfected with HCV and HBV.


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.


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).


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.


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 monoinfected patients so as to improve diagnostic algorithms.

Keywords: HIV infection, hypertransaminasemia, steatosis, fibrosis..