{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:31:11Z","timestamp":1789594271793,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>(1) Background: Developing strategies to identify significant liver fibrosis in people with HIV (PWH) is crucial to prevent complications of non-alcoholic fatty liver disease (NAFLD). We aim to investigate if five simple serum biomarkers applied to PWH can optimize a care pathway to identify significant liver fibrosis defined by transient elastography (TE). (2) Methods: A two-tier fibrosis pathway was applied to three prospective cohorts of PWH undergoing TE with CAP. NAFLD was diagnosed as a controlled attenuation parameter \u2265 248 dB\/m. Five simple fibrosis biomarkers (FIB-4 &lt; 1.3, BARD score 0\u20131, NAFLD fibrosis score &lt; \u22121.455, AST:ALT ratio &lt; 0.8 and APRI &lt; 0.5) were applied as first-tiers to exclude significant liver fibrosis. We determined the decrease in referral for TE that would have occurred based on biomarker assessment and the discordance between low simple fibrosis biomarkers and high TE (\u22657.1 kPa), indicating significant liver fibrosis. (3) Results: Of the 1749 consecutive PWH, 15.1% had significant liver fibrosis by TE and 39.1% had NAFLD. The application of the fibrosis biomarkers as first tiers would have resulted in a decrease in TE referrals between 24.9% (BARD score) and 86.3% (APRI). The lowest discordance rate was with NAFLD fibrosis score (8.5%). After adjustments, BMI (odds ratio (OR) 1.12, 95% CI: 1.08\u20131.17) and triglycerides (OR 1.26, 95% CI: 1.11\u20131.44) were independent predictors of discordance for APRI &lt; 0.5 and TE \u2265 7.1. The performance of the two-tier pathways was similar in PWH with and without NAFLD. (4) Conclusions: Implementing a two-tier pathway could save a substantial proportion up of TE examinations, reducing costs and helping resource optimization in HIV care. Patients with metabolic risk factors for NAFLD and low fibrosis biomarker may still be considered for TE referral.<\/jats:p>","DOI":"10.3390\/jpm12020282","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T22:44:47Z","timestamp":1644965087000},"page":"282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2655-8283","authenticated-orcid":false,"given":"Giada","family":"Sebastiani","sequence":"first","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"},{"name":"Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"},{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jovana","family":"Milic","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"},{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Cervo","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"},{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0224-379X","authenticated-orcid":false,"given":"Sahar","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\u2014Infectious Disease, Center for Dissemination and Implementation, Institute for Public Health, School of Medicine, Washington University, St. Louis, MO 63110-1010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Krahn","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Kablawi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al Shaima","family":"Al Hinai","sequence":"additional","affiliation":[{"name":"Division of Experimental Medicine, McGill University, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1273-9393","authenticated-orcid":false,"given":"Bertrand","family":"Lebouch\u00e9","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"},{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"},{"name":"Department of Family Medicine, McGill University, Montr\u00e9al, QC H3S 1Z1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Deschenes","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Gio\u00e8","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1992-1796","authenticated-orcid":false,"given":"Antonio","family":"Cascio","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"},{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Mazzola","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, S. Elia Hospital, 93100 Caltanissetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Guaraldi","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"},{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/hep.28524","article-title":"The globalization of nonalcoholic fatty liver disease: Prevalence and impact on world health","volume":"64","author":"Rinella","year":"2016","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1097\/QAD.0000000000002233","article-title":"Clinical significance of elevated liver transaminases in HIV-infected patients","volume":"33","author":"Cai","year":"2019","journal-title":"AIDS"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/QCO.0b013e32834ef599","article-title":"From nonalcoholic fatty liver to nonalcoholic steatohepatitis and cirrhosis in HIV-infected patients: Diagnosis and management","volume":"25","author":"Lemoine","year":"2012","journal-title":"Curr. 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