The aspartate aminotransferase to platelet ratio index for assessing hepatic fibrosis in human immunodeficiency virus-hepatitis C virus coinfected patients: A local experience

Background: HCV infection is widespread among HIV infected populations because of their increased life expectancy with the advent of HAART. Hepatic fibrosis is one of the most robust prognostic factors used to predict HCV disease progression and clinical outcomes. This study's objective was to evaluate hepatic fibrosis using APRI in HIV-HCV co-infected individuals compared to HIV monoinfected. Methods: A total of 120 HIV infected patients (mean age 41.7±10.0 years) was enrolled in a study conducted in JNIMS, Manipur from August 2017 to August 2019. Liver fibrosis was assessed by the APRI which signifies the presence and absence of significant fibrosis if APRI > 1.5 and APRI < 0.5 respectively. Correlation between hepatic fibrosis and immunological status was established. Statistical analysis was done using SPSS version 21. Results: HIV-HCV co-infected patients had a higher abnormal mean AST level (114.18±150.19 IU/L) than HIV monoinfected (65.03±47.71 IU/L). The mean platelet count in HIV-HCV co-infected patients (106±38×103 cells/mm3) was lower than that of HIV monoinfected (207±80×103 cells/mm3). The mean APRI score in HIV-HCV co-infected patients (3.05±3.89) was higher than that in HIV monoinfected (1.02±1.38) indicating the presence of significant hepatic fibrosis in the co-infected group (p<.001). Conclusion: A high AST level combined with thrombocytopenia (APRI score>1.5) is an indicator of hepatic fibrosis in HIV-HCV co-infected individuals. Our study demonstrates that HIV-HCV co-infected patients and HIV related advanced immunosuppression is associated with higher APRI. Because of its simple, non-invasive and less costly nature, APRI may be utilised for assessing hepatic fibrosis in resource-limited settings.