CD4 Discordance as a Predictor of Liver Fibrosis in People Coinfected with Human Immune Deficiency Virus/Hepatitis C Virus: A Cross-Sectional Study.

Abstract

Liver fibrosis presents a unique diagnostic challenge in people coinfected with hepatitis C virus (HCV) and human immune deficiency virus (HIV). This study aimed to explore the association between CD4 discordance and liver fibrosis in that population, alongside assessing the predictive power of different models for significant fibrosis. A cross-sectional study was conducted on 198 adult people with HIV/HCV coinfection. Liver fibrosis was noninvasively assessed using transient elastography, and CD4 discordance was defined based on the discrepancy between absolute CD4 cell count and CD4 cell percentage. Multivariate logistic regression and receiver operating characteristic curves were used for analysis. Only 52 (26.3%) individuals had concordant CD4 values. The study found a significant correlation between high CD4 discordance and significant liver fibrosis (p < .001), with a higher prevalence of significant fibrosis in those with high discordance (65.5%) than those with low (14.5%) or concordant (13.5%) CD4 values. High CD4 discordance was strongly associated with significant fibrosis (odds ratio = 11.48, p < .001). The CD4-only model showed a high negative predictive value (87.5%), making it suitable for excluding significant fibrosis. In contrast, models incorporating both CD4 count and percentage demonstrated higher positive and negative predictive values (78.6% and 87.6%, respectively), indicating their utility in diagnosing significant fibrosis. This study highlights the complexity of assessing liver fibrosis in HIV/HCV-coinfected individuals and underscores the value of CD4 discordance as a predictive factor. The predictive models, especially those combining CD4 count and percentage, provide an approach for evaluating liver fibrosis. Further research is needed to refine these models and enhance their clinical applicability.