INTRODUCTION. The Needle (and the Damage Done)

Liver biopsy is the gold standard for diagnosis of advanced hepatic fibrosis, but has been progressively replaced by noninvasive testing. Sterling et al. conducted a multicenter, cross-sectional study evaluating the discriminatory capacity of noninvasive markers of fibrosis—including vibration-controlled transient elastography (VCTE), aspartate aminotransferase-to-platelet ratio index (APRI), and Fibrosis-4 index (FIB-4)—and compared them to liver biopsy in 108 patients with hepatitis B virus and human immunodeficiency virus (HBV-HIV) coinfection. The investigators noted that VCTE was accurate at excluding and diagnosing advanced fibrosis while addition of APRI or FIB-4 did not improve discriminatory capacity. Possible explanations include the laboratory score reliance on transaminase levels, which can be normal while on HBV treatment. In summary, the accuracy of VCTE in assessing advanced fibrosis in HBV-HIV patients appears to be excellent, but not enhanced by simple serum tests. (Hepat ology 2020;71:411-421).