Montreal Researchers Develop New Method For Liver Fibrosis Screening Among HIV Patients

Researchers at the McGill University Health Centre (MUHC) in Montreal have developed a new method for screening for liver fibrosis among HIV patients which they say are more effective compared to the commonly used test.

Liver fibrosis which is the build-up of scar tissue in the liver can lead to permanent damage and is one of the leading causes of death among those living with an HIV infection.

According to a study published in the Hepatology journal, researchers found that the commonly used FIB-4 blood test to detect scarring of liver tissue mis-classified over a third of the cases as low risk.

FIB-4 was particularly poor at detecting fibrosis among those with certain forms of steatotic liver disease (SLD), previously known as fatty liver disease. SLD affects one in three adults globally and can lead to liver fibrosis.

The findings were based on nearly 5,000 participants from five countries who were followed between 2015 and 2025. Patients didn’t have an active viral hepatitis or hazardous alcohol use.

“Most participants with significant liver fibrosis who were incorrectly classified as low risk by the FIB-4 score remained in that category when the test was repeated 12 and 24 months later,” researchers said in a press release. “As a result, they would likely not have received the clinical follow-up needed in routine practice.”

Scientists at the MUHC developed an alternative screening technique by analyzing the characteristics of people whose liver fibrosis was missed by the FIB-4 test to improve the risk classification.

In the newly developed method, scientists compute a FIB-HIV score using routinely available clinical information and traditional risk factors such as overweight, obesity, diabetes and high blood pressure, as well as HIV-specific factors, including exposure to certain older antiretroviral drugs, duration of HIV infection, the severity of past immune suppression and viral load.

“In people living with HIV, several factors can contribute to liver damage without significantly affecting the blood markers used to calculate the FIB-4 score,” says Felice Cinque, author of the study and former postdoctoral fellow at MUHC.

“This highlights the importance of accounting for individual metabolic and HIV-related factors, such as those incorporated into the FIB-HIV score, to achieve a more accurate assessment of liver fibrosis risk.”

Dr. Giada Sebastiani, associate professor at McGill University and scientist at MUHC, said she hoped the new method will help improve liver fibrosis screening, especially as people living with HIV continue to get older, which increases the risk.

“In high-income countries, nearly half of all people living with HIV are now over the age of 50,” Sebastiani said. “As this population continues to age, liver disease is becoming an increasingly important health concern.”

“We hope our findings will help advance a more personalized and effective approach to liver fibrosis screening,”