Researchers at the McGill University Health Centre in Montreal have developed a new method for screening liver fibrosis among HIV patients that is more effective than commonly used tests, according to a study published in the Hepatology journal. Liver fibrosis involves the build-up of scar tissue in the liver, which can lead to permanent damage and stands as a leading cause of death among people living with an HIV infection.
Limitations of the Traditional FIB-4 Blood Test
According to the study, researchers found that the commonly used FIB-4 blood test misclassified over a third of liver scarring cases as low risk. The evaluation showed that FIB-4 performed poorly at detecting fibrosis among patients with certain forms of steatotic liver disease, previously known as fatty liver disease. Steatotic liver disease affects one in three adults globally and can lead directly to liver fibrosis.
The findings draw on nearly 5,000 participants from five countries monitored between 2015 and 2025. Participants included in the study did not have 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 stated in a press release. “As a result, they would likely not have received the clinical follow-up needed in routine practice.”
The New FIB-HIV Screening Method
To address these diagnostic gaps, scientists at the McGill University Health Centre analyzed the characteristics of patients whose liver fibrosis was missed by the traditional FIB-4 test. This analysis led to an alternative screening technique designed to improve risk classification.
Under the newly developed approach, scientists compute a FIB-HIV score using routinely available clinical information alongside traditional risk factors like overweight, obesity, diabetes, and high blood pressure. The calculation also integrates HIV-specific factors, such as exposure to older antiretroviral drugs, the 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,” said Felice Cinque, author of the study and former postdoctoral fellow at the McGill University Health Centre. “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.”
Addressing Aging Populations With HIV
Dr. Giada Sebastiani, an associate professor at McGill University and scientist at the McGill University Health Centre, expressed hope that the new method will improve screening protocols as the demographics of the HIV-positive population continue to shift.
“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.”
Did You Know?
Frequently Asked Questions
What is liver fibrosis?
Why does the FIB-4 test miss cases in HIV patients?
According to the McGill University Health Centre researchers, the standard FIB-4 blood test fails to account for specific metabolic and HIV-related factors—such as older antiretroviral exposure and immune suppression history—that contribute to liver damage.
How does the FIB-HIV score differ?
The FIB-HIV score combines traditional clinical markers like diabetes and obesity with HIV-specific variables to deliver a more accurate assessment of liver fibrosis risk.
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