Transient elastography (Fibroscan) in HIV-1 vertically infected children. A cross-sectional study

Abstract

Progressive liver toxicity is a concern in HIV-infected patients. Although liver biopsy remains the gold standard for liver assessment, its invasiveness, sampling errors, variability in interpretation and expense do not make it an ideal routine follow-up exam. During the last decade, new non-invasive tools have been developed for the assessment of hepatic fibrosis in HCV and HIV/HCV co-infected patients. The aim of this cross-sectional study was to evaluate the feasibility of transient elastography (TE) measuring liver stiffness in chronically HIV-infected children. Inclusion criteria were: materno-foetal transmission, age 8 to 18 years old, informed parental consent and patient assent. Twenty-one HIV-1 chronically infected children were included. There were 11 girls and 10 boys, with a median age of 13.2 years (8.3-17.3). Five were HIV stage N, 3 were stage A, 6 were stage B and 6 suffered from AIDS definition illness (stage C). For one orphan child HIV CDC status could not be determined. Mean weight was 46.7 kg (18.4-83.5), mean height was 151.2 cm (116-175). Mean CD4 T-cell count at inclusion was 669 cells/mm3 (256-1,252) or 29.9% (9.4-45%), mean viral load was 3.88 log10 copies/mm3 (1.60-4.83). Eight children had undetectable viral load (<40 copies/mm3). At the time of enrolment, 10 patients received conventional HAART with two NRTIs (nucleoside reverse transcriptase inhibitor) and 1 PI (protease inhibitor), 4 received 2 NRTIs + 1 NNRTI (non-nucleoside reverse transcriptase inhibitor), 2 patients were on dual NRTI association, 1 was on triple NRTI combination and 1 were receiving 1 drug of each class (NRTI+NNRTI+PI). Three children were on planned treatment interruption. All patients underwent a Fibroscan exam. The two youngest children failed in having a TE measure because of technical difficulties due to their small corpulence. The average measurement success rate was 96.7%. HIVinfected patients had significantly higher TE results than matched healthy control children (5.92 +/- 1.60 versus 4.34 +/- 1.10 kPa) (p < 0.02). Furthermore, loss of elasticity assessed by TE measures tended to increase with age in a linear manner (adjusted R2: 0.208, p < 0.03). This correlation was found only in the HIV-infected group. We therefore hypothesized that HIV infection and/or continuous exposure to antiretroviral treatment were responsible for this relation. Our results showed that 1 - evaluation of liver stiffness is feasible in most HIV-1 chronically infected children. 2 - Patients had significantly higher TE results than matched healthy control children 3 - the loss of elasticity tended to increase with age in a linear manner. Liver injury should be monitored on a regular basis. The place of TE in the management of these children must be further defined.