When we applied the high HGM-3 cut-off (>0.570) to the estimation group, 31 patients were correctly identified (true positive with advanced fibrosis), and only five patients were misclassified (false positive without advanced fibrosis) (Table 5). We found the presence of F≥3 with 86.1% certainty. The LR+ was very high and the DOR was >40. The percentage of patients correctly

identified was >80%. However, the diagnostic accuracy values for the validation group were slightly worse than those for the estimation group, but the difference was not statistically significant (Table 5). We found the presence of F≥3 CHIR-99021 cell line with 76.9% certainty. The sensitivity value was lower, and the LR+ and DOR were also lower than for the estimation group. In this study, we aimed to develop a noninvasive index in order to identify advanced liver fibrosis in a series of 195 HIV/HCV-coinfected patients naïve to anti-HCV treatment. Patients were randomly divided into an estimation group and a validation group. We assessed routine laboratory data as well as markers of extracellular matrix (ECM) metabolism, inflammation, growth factors and IR. In the estimation group, univariate analyses revealed that platelet count, ALP, HGF, TIMP-1 and HA were all associated with advanced liver fibrosis. With these markers, we developed a new index using a logistic probability function which we have designated HGM-3. We did not

included ‘time on Selleckchem SAHA HDAC HAART’ in the final model because the models with and without ‘time on HAART’ were not significantly different. Moreover, it is

often difficult to calculate the time on HAART for patients who change their centre of reference several times or for whom the clinical history is incomplete. HGM-3 had an AUC-ROC for the identification of advanced liver fibrosis Tangeritin higher than 0.90, which was significantly higher than the AUC-ROC obtained with the HGM-2, FIB-4, APRI or Forns’ index. These results confirm that HGM-3 is an accurate noninvasive method for the detection of bridging fibrosis and cirrhosis in HIV/HCV-coinfected patients. Liver fibrosis is considered a dynamic process characterized by matrix remodelling and excessive deposition of ECM proteins including collagen [25,26]. Currently, two types of serum markers of liver fibrosis have been used: indirect markers that reflect alterations in hepatic function but do not directly reflect ECM metabolism (i.e. platelet count, coagulation studies, etc.), and direct markers that reflect qualitative and quantitative changes in ECM macromolecules [9]. We evaluated a variety of standard indirect markers of liver fibrosis. By multivariate analysis, we found platelet count and ALP to be independent predictive markers of advanced fibrosis. Our findings echo the results of many previous studies which showed that platelet count and ALP levels were important predictors of either significant fibrosis or cirrhosis [27].