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In our study, the lowest discordance rate was found when FS and APRI score were
considered. This could be possibly due to the small number of biochemical parameters used
in the APRI score (AST and platelet count), compared to those needed for FT. Also, certain
parameters used in the FT, such as GGT or bilirubin, are known to be influenced by
antiretroviral treatment.
Several factors were identified to be associated to a discordant result between FT and FS or
FT and APRI. These factors included: male gender, age >45 years, GGT>1.5N, total
bilirubin>17µmol/L, α2-macroglobulin>3g/L and a low apolipoprotein A1 level, as well as the
presence of lipodystrophy. Elevated α2-macroglobulin which is also a marker of
inflammation, has already been reported to be a risk factor of FT failure (28).
In our cohort, most coinfected patients were under antiretroviral drugs, among which some
are known to influence the level of several biological parameters. For example, atazanavir
which was the most used protease inhibitor in our study (25% of patients), is known to be
associated with an increase in unconjugated bilirubin, due to an inhibition of the hepatic
enzyme UDP-glucuronosyltransferase (UGT) (29). Other drugs such as non-nucleoside
reverse transcriptase inhibitors (NNRTI) are known to induce an elevation of GGT (30).
However, no association was found between discordance and nevirapine or efavirenz, the
two NNRTI mostly used in this study. Conversely, in univariate analysis, atazanavir was
associated with a discordance between FT and FS and between FT and APRI. These results
seem to indicate that modifications of biochemical parameters due to antiretroviral toxicity
might lead to FT failure.
In addition, our study also found lipodystrophy to be a risk factor for discordance between FT
and FS. Indirectly, this finding further supports the toxicity role of antiretroviral drugs in the
increase in biochemical parameters and consequently in the occurrence of discordances. In
addition, lipodystrophy has been found to be associated with steatosis and metabolic
syndrome, conditions which could lead to an increase of liver stiffness value (31-33).
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