USE OF THE FIBROSIS-4 INDEX FOR SCREENING LIVER FIBROSIS IN PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS AND GLUCOSE METABOLISM DISORDERSBackground and Objective: To evaluate the performance of the Fibrosis-4 (FIB-4) index for liver fibrosis screening in people living with HIV (PLWH) with glucose metabolism disorders (diabetes and prediabetes).
Methods: Cross-sectional study including 100 PLWH on continuous antiretroviral therapy at a reference center in Brazil (March-November 2025). Clinical, laboratory, and ultrasonographic data were collected for FIB-4 calculation. Participants with diabetes were compared to non-diabetic individuals.
Results: Altered FIB-4 values were observed in 32 participants, with no sex differences. Mild steatosis (S≥1) was present in 47.0%, and clinically significant steatosis (S≥2) in 11.0%. S≥1 was associated with higher BMI, waist circumference, visceral fat, total cholesterol, LDL, triglycerides, and ALT levels. FIB-4 showed limited ability to classify S≥2.
Conclusion: FIB-4 is useful for fibrosis screening, particularly to exclude advanced disease, but does not adequately identify clinically significant steatosis (S≥2). Its use should be combined with metabolic assessment and elastography when values are ≥1.3.
Keywords:
HIV; non-alcoholic fatty liver disease; diabetes mellitus
FIB-4 is effective as a first-line noninvasive tool to screen liver fibrosis, particularly to rule out advanced disease due to its high negative predictive value.
FIB-4 shows poor performance for detecting clinically significant steatosis (S≥2), with low sensitivity at standard cutoffs.
32% had elevated FIB-4; steatosis prevalence was 47% (S≥1) and 11% (S≥2), with no sex differences.
FIB-4 ≥1.3 should prompt further evaluation with elastography and metabolic assessment, as it is insufficient as a standalone tool for steatosis detection.