Liver disease and HIV: Study reveals major gaps in liver fibrosis screening and offers a promising solution

A recent international study has highlighted significant gaps in detecting liver fibrosis among people living with HIV, a condition that often goes unnoticed despite its prevalence and potential for severe outcomes. Liver fibrosis, a buildup of scar tissue in the liver, can lead to permanent damage and, in advanced stages, cirrhosis or liver cancer, posing a major public health challenge.

While antiretroviral therapy and improved control of viral hepatitis have generally improved the health of people living with HIV, liver disease remains a leading cause of death in this population.

The FIB-4 blood test, a widely used screening tool, has proven to be only moderately effective in identifying significant liver fibrosis among people with HIV. It misclassifies 36% of fibrosis cases as low risk, particularly among those with metabolic dysfunction-associated steatotic liver disease (MASLD), a condition characterized by an excessive buildup of fat in the liver.

The study, led by Dr. Giada Sebastiani from the Research Institute of the McGill University Health Centre, introduces the FIB-HIV score, a new tool that incorporates metabolic and HIV-specific factors to improve the identification of individuals at risk of liver fibrosis.

The FIB-HIV score, which takes into account traditional metabolic risk factors such as overweight, obesity, diabetes, and high blood pressure, as well as HIV-specific factors including exposure to certain antiretroviral drugs, duration of HIV infection, severity of past immune suppression, and viral load, outperformed the FIB-4 score in detecting significant liver fibrosis.

By incorporating these additional factors, the FIB-HIV score achieved a higher accuracy in identifying individuals who would benefit from further diagnostic testing, such as transient elastography, an imaging technique that measures scar tissue in the liver.

The study, which included nearly 5,000 participants followed between 2015 and 2025 across seven centers in five countries, found that over one-third of cases of significant liver fibrosis were missed by the FIB-4 test. Among participants with liver fibrosis, the FIB-HIV score correctly identified 93.9% of cases, compared to only 63.7% when using the FIB-4 score.

These findings underscore the importance of adopting a more personalized and comprehensive approach to liver fibrosis screening in people living with HIV, particularly as the population continues to age. The FIB-HIV score, based on routinely available clinical information, could help clinicians better identify patients who require transient elastography, ultimately optimizing the use of diagnostic resources and improving patient outcomes.