Trends in the use of liver biopsy in HIV-infected patients

Background: Liver biopsy remains the gold standard investigation for diagnosis and assessment of severity of hepatic disease. It has previously been the method of choice to determine the degree of fibrosis or cirrhosis guiding therapy for viral hepatitis; however with the advent of non-invasive methods for detecting changes in liver architecture such as transient elastography (e.g. Fibroscan TM ) and novel serum biomarkers of hepatic damage we hypothesised that uptake of liver biopsy in HIV infected patients over the last decade would have declined.
Methods: We performed a retrospective descriptive analysis of liver biopsies performed in HIV positive patients treated at a teaching hospital between January 2002 and July 2012. Investigation was restricted to diagnostic biopsies and those performed for staging and grading of fibrotic liver disease. Primary data were collected regarding biopsy use over this period, indication for biopsy and hepatitis co-infection status.
Results: During the study period 259 patients of a cohort of 4245 HIV positive patients underwent liver biopsy. A total of 313 biopsy specimens were received of which 4 were discounted as not meeting inclusion criteria leaving 309 biopsies for analysis. 40% of patients who underwent biopsy were co-infected with hepatitis C virus and 13% with hepatitis B as indicated by biopsy details. 38% of biopsies were performed for staging of known fibrosis/cirrhosis; 42% were performed for deranged liver function tests; and 7% for investigation of a mass or neoplastic lesion. Other less common indications included assessment of non-alcoholic steatohepatitis and diagnosis of suspected underlying cirrhosis without biochemical derangement. Biopsy rates ranged between 10 per year and 53 per year with no clear trend in annual usage. Subgroup analysis failed to suggest a fall in those performed for staging of known fibrosis.
Conclusion: In summary despite the introduction and availability of non- invasive methods for staging fibrosis we could find no evidence of a decrease in the use of liver biopsy as a strategy for measurement of fibrosis or as a diagnostic tool.