2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T707,Steatotic liver disease (SLD) and liver fibrosis are major comorbidities in people with HIV (PWH). Guidelines recommend stepwise screening using the Fibrosis-4 (FIB-4) index followed by transient elastography (TE), yet its accuracy and the extent of FIB-4 misclassification in PWH remain uncertain. We evaluated the diagnostic performance of FIB-4 against TE, quantified missed fibrosis, and assessed whether metabolic and HIV-specific factors improve risk prediction. We conducted a multinational study of 4,917 PWH without viral hepatitis coinfection or hazardous alcohol intake undergoing TE screening across seven centers. SLD was defined by controlled attenuation parameter >275 dB/m and classified as metabolic dysfunction-associated SLD (MASLD) or metabolic dysfunction-associated alcohol-related liver disease (MetALD). Significant fibrosis (liver stiffness measurement [LSM] ≥8 kPa) was present in 12.6% of participants, advanced fibrosis (LSM ≥11 kPa) in 6.1%, and SLD in 21.7% (20.6% MASLD, 1.1% MetALD). FIB-4 showed modest accuracy for significant fibrosis (AUROC 0.69, 95% CI 0.67-0.72) and misclassified 36% of fibrosis cases as low risk (FIB-4 <1.3). Performance was poorer in MASLD than in non-MASLD (AUROC 0.60 vs 0.76; p <0.001). Participants with false-negative FIB-4 exhibited a more metabolic phenotype, including higher BMI and steatosis. Incorporating metabolic and HIV-specific factors improved discrimination and reclassification and enabled development of the FIB-HIV score, which outperformed FIB-4 (AUROC 0.78 vs 0.69; p <0.001). In PWH, liver fibrosis is common and frequently missed by FIB-4, particularly in MASLD. TE-centered screening strategies augmented by metabolic and HIV-specific indicators may improve early fibrosis detection and risk stratification.31:T9b6, Background and Aims: Steatotic liver disease (SLD) and liver fibrosis are major comorbidities in people with HIV (PWH). Guidelines recommend stepwise screening using the Fibrosis-4 (FIB-4) index followed by transient elastography (TE), yet its accuracy and the extent of FIB-4 misclassification in PWH remain uncertain. We evaluated the diagnostic performance of FIB-4 against TE, quantified missed fibrosis, and assessed whether metabolic and HIV-specific factors improve risk prediction. Approach and Results: We conducted a multinational study of 4,917 PWH without viral hepatitis coinfection or hazardous alcohol intake undergoing TE screening across seven centers. SLD was defined by controlled attenuation parameter >275 dB/m and classified as metabolic dysfunction-associated SLD (MASLD) or metabolic dysfunction-associated alcohol-related liver disease (MetALD). Significant fibrosis (liver stiffness measurement [LSM] ≥8 kPa) was present in 12.6% of participants, advanced fibrosis (LSM ≥11 kPa) in 6.1%, and SLD in 21.7% (20.6% MASLD, 1.1% MetALD). FIB-4 showed modest accuracy for significant fibrosis (AUROC 0.69, 95% CI 0.67–0.72) and misclassified 36% of fibrosis cases as low risk (FIB-4 <1.3). Performance was poorer in MASLD than in non-MASLD (AUROC 0.60 vs 0.76; p <0.001). Participants with false-negative FIB-4 exhibited a more metabolic phenotype, including higher BMI and steatosis. Incorporating metabolic and HIV-specific factors improved discrimination and reclassification and enabled development of the FIB-HIV score, which outperformed FIB-4 (AUROC 0.78 vs 0.69; p <0.001). Conclusions: In PWH, liver fibrosis is common and frequently missed by FIB-4, particularly in MASLD. TE-centered screening strategies augmented by metabolic and HIV-specific indicators may improve early fibrosis detection and risk stratification. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Fibrosis Biomarker Index: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Fibrosis Biomarker Index (modality). Clinician-written summaries and actionable practice insights. 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HIV: A large multinational screening study","journal_title":"Hepatology","journal_issn":"0270-9139","published_at":"2026-05-01T00:00:00.000Z","url":"https://doi.org/10.1097/hep.0000000000001773","source_score":22,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-08","doi":"10.1097/hep.0000000000001773","days":"7","issn":"0270-9139","rank":"5","field":"Clinical Medicine","score":"22","category":"Gastroenterology & Hepatology","categories":["Gastroenterology & Hepatology"],"_categories":["Gastroenterology & Hepatology"]},"pubmed":{"doi":"10.1097/HEP.0000000000001773","title":"FIB-4 fails to identify significant liver fibrosis in people with HIV: A large multinational screening study.","journal":"Hepatology (Baltimore, Md.)","methods":"","results":"","abstract":"$30","keywords":["FIB-HIV","MASLD","lean phenotype","metabolic risk factors","misclassification","transient elastography"],"pubmed_id":"42065895","conclusions":"","publication_date":"2026-05-01T00:00:00"},"crossref":{"DOI":"10.1097/hep.0000000000001773","URL":"https://doi.org/10.1097/hep.0000000000001773","ISSN":["0270-9139","1527-3350"],"link":[{"URL":"https://journals.lww.com/10.1097/HEP.0000000000001773","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["FIB-4 fails to identify significant liver fibrosis in people with HIV: A large multinational screening study"],"author":[{"given":"Felice","family":"Cinque","sequence":"first","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada"},{"name":"Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy"}]},{"given":"Sahar","family":"Saeed","sequence":"additional","affiliation":[{"name":"Public Health Sciences, Queen’s University, Kingston, ON, Canada"}]},{"given":"Francesca","family":"Farina","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada"},{"name":"San Raffaele Hospital, Milan, Italy"}]},{"given":"Dana","family":"Kablawi","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada"}]},{"given":"Jihoon","family":"Lim","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada"}]},{"given":"Antonio","family":"Cascio","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences and Mother and Child Care “Giuseppe D’Alessandro”, University of Palermo, Palermo, Italy"}]},{"given":"Claudia","family":"Gioè","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences and Mother and Child Care “Giuseppe D’Alessandro”, University of Palermo, Palermo, Italy"}]},{"given":"Emmanuel","family":"Tsochatzis","sequence":"additional","affiliation":[{"name":"UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK"}]},{"given":"Rosa","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy"},{"name":"SC Medicina Indirizzo Metabolico, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy"}]},{"given":"Ahmed","family":"Cordie","sequence":"additional","affiliation":[{"name":"Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt"}]},{"given":"Rahma","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt"}]},{"given":"Ahmed M.","family":"Kamel","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt"}]},{"given":"Gamal","family":"Esmat","sequence":"additional","affiliation":[{"name":"Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt"},{"name":"Research Center, Badr University in Cairo, Badr City, Egypt"}]},{"given":"Alessandra","family":"Bandera","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy"},{"name":"Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy"}]},{"given":"Jovana","family":"Milic","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy"}]},{"given":"Dominik","family":"Benke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, Bonn, Germany"}]},{"given":"Fauzi","family":"Elamouri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, Bonn, Germany"}]},{"given":"Jürgen K.","family":"Rockstroh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Venusberg Campus 1, University Hospital Bonn, Bonn, Germany"}]},{"given":"Giovanni","family":"Guaraldi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy"}]},{"given":"Giada","family":"Sebastiani","sequence":"additional","affiliation":[{"name":"Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada"},{"name":"Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada"},{"name":"Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada"}]}],"issued":{"date-parts":[[2026,5,1]]},"member":"276","prefix":"10.1097","source":"Crossref","volume":null,"created":{"date-time":"2026-05-01T16:00:14Z","timestamp":1777651214000,"date-parts":[[2026,5,1]]},"indexed":{"date-time":"2026-05-07T10:15:07Z","timestamp":1778148907187,"date-parts":[[2026,5,7]]},"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://journals.lww.com/10.1097/HEP.0000000000001773"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","value":"2026-02-04"},{"name":"accepted","group":{"name":"publication_history","label":"Publication History"},"label":"Accepted","value":"2026-04-04"}],"deposited":{"date-time":"2026-05-07T10:00:49Z","timestamp":1778148049000,"date-parts":[[2026,5,7]]},"issn-type":[{"type":"print","value":"0270-9139"},{"type":"electronic","value":"1527-3350"}],"published":{"date-parts":[[2026,5,1]]},"publisher":"Ovid 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age_group and sex tags reflect reasonable assumptions for an HIV clinic population.","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001773","tag_type":"warning","value":"The FIB-HIV score is newly derived in this study; external validation data are not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1097/hep.0000000000001773","tag_type":"warning","value":"The full text retrieved appears to contain an unrelated document (a 2020 GI Society joint statement on racism), not the actual study body. Summary and tags are based solely on the abstract, which provides sufficient detail for most fields but precludes extraction of subgroup data, adjustment variables, or methodological specifics from the full text.","value_numeric":null}],"summaries":{"what_studied":"Diagnostic accuracy of FIB-4 index vs. transient elastography (TE) for significant liver fibrosis in 4,917 people with HIV (PWH) without viral hepatitis coinfection or hazardous alcohol use, across seven multinational centers; also assessed whether metabolic and HIV-specific factors could improve risk prediction.","key_result":"FIB-4 showed only modest accuracy for significant fibrosis (AUROC 0.69) and missed 36% of cases (false-negative rate at FIB-4 <1.3 cutoff); performance was worse in MASLD vs. non-MASLD (AUROC 0.60 vs. 0.76, p<0.001). A new FIB-HIV score incorporating metabolic and HIV-specific factors outperformed FIB-4 (AUROC 0.78 vs. 0.69, p<0.001). Significant fibrosis (LSM ≥8 kPa) was present in 12.6% and SLD in 21.7% of participants.","limitations":"- Observational, cross-sectional design limits causal inference and assessment of clinical outcomes.\n- TE used as reference standard rather than liver biopsy, which may affect fibrosis classification accuracy.\n- The FIB-HIV score was derived and not externally validated in an independent cohort.","practice_takeaway":"FIB-4 alone should not be relied upon to rule out significant fibrosis in PWH, especially those with metabolic risk factors or MASLD — TE-based screening is more appropriate in this population. Clinicians should consider metabolic and HIV-specific factors when stratifying fibrosis risk in PWH."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Fibrosis Biomarker Index"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Fibrosis Biomarker Index"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Fibrosis Biomarker Index"}}}]]

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