***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Human immunodeficiency virus (HIV)/hepatitis C virus ( HCV ) coinfection is associated with progressive liver disease . However , the rate of progression is variable and the ability to differentiate patients with stable versus progressive HCV disease is limited . The objective of this study was to assess the incidence of and risk factors for fibrosis progression in a prospect i ve cohort of coinfected patients . Overall , 435 liver biopsy pairs from 282 patients without cirrhosis were analyzed . Biopsies were scored according to the METAVIR system by a single pathologist blind to biopsy sequence . Fibrosis progression was defined as an increase of at least one METAVIR fibrosis stage between paired biopsies . The majority of patients were African American ( 84.8 % ) , male ( 67.7 % ) , and infected with HCV genotype 1 ( 93.4 % ) . On initial biopsy ,  no or minimal fibrosis was identified in 243 patients ( 86 % ) . The median interval between biopsies was 2.5 years . Fibrosis progression was observed in 97 of 282 ( 34 % ) patients and 149 of 435 ( 34 % ) biopsy pairs . After adjustment , greater body mass index ( adjusted odds ratio [ aOR ] : 1.04 per 1 unit increase ) , diabetes ( aOR : 1.56 ) , and hepatic steatosis ( aOR : 1.78 ) at the time of initial biopsy were marginally associated with subsequent fibrosis progression . Between biopsies , elevated serum aspartate and alanine aminotransferase ( AST , ALT ) ( aOR AST : 3.34 , ALT : 2.18 for > 25 % values > 100 U/L versus < 25 % values > 100 U/L ) were strongly associated with fibrosis progression . CONCLUSION Fibrosis progression is common among HIV/HCV coinfected patients ; these data suggest that progression can be rapid . Persistent elevations in serum transaminase levels may serve as important noninvasive markers to identify subsets of patients who are more likely to progress and thus warrant closer monitoring and consideration of HCV treatment BACKGROUND FibroTest , a noninvasive method of measuring biomarkers of liver fibrosis , is an alternative to liver biopsy for determining the severity of chronic hepatitis C virus ( HCV ) infection . We compared the 5-year prognostic value of the FibroTest with biopsy staging for predicting cirrhosis decompensation and survival in patients with chronic HCV infection . METHODS Fibrosis stage was assessed on the same day by FibroTest and biopsy in a prospect i ve cohort of 537 patients . Disease classification at baseline was 157 patients with severe fibrosis ( FibroTest > 0.58 ) , 137 with moderate fibrosis ( FibroTest 0.32 - 0.58 ) , and 243 with no or minimal fibrosis ( FibroTest < 0.32 ) . RESULTS In 64 untreated patients with severe fibrosis , survival without HCV complications was 73 % [ 95 % confidence interval ( CI ) , 59%-086 % ; 13 complications ] , and survival without HCV-related death was 85 % ( 95 % CI , 73%-96 % ; 7 HCV deaths ) . Survival rates were higher in patients with moderate fibrosis , [ 99 % ( 95 % CI , 97%-100 % ; 1 complication ; P < 0.001 ) and 100 % ( no HCV death ; P < 0.001 ) for patients with and without HCV-related complications , respectively ] , and in patients with minimal fibrosis [ 100 % ( no complication ; P < 0.001 vs severe ) and 100 % ( no HCV death ; P < 0.001 vs severe ) , respectively ] . FibroTest was a better predictor than biopsy staging for HCV complications , with area under the ROC curves ( AUROC ) = 0.96 ( 95 % CI , 0.93%-0.97 % ) vs 0.91 ( 95 % CI , 0.85%-0.94 % ; P = 0.01 ) , respectively ; it was also a better predictor for HCV deaths : AUROC = 0.96 ( 95 % CI , 0.93%-0.98 % ) vs 0.87 ( 95 % CI , 0.70%-0.94 % ; P = 0.046 ) , respectively . The prognostic value of FibroTest was still significant ( P < 0.001 ) in multivariate analyses after taking into account histology , treatment , alcohol consumption , and HIV coinfection . CONCLUSION The FibroTest measurement of HCV biomarkers has a 5-year prognostic value similar to that of liver biopsy IMPORTANCE Patients co-infected with human immunodeficiency virus ( HIV ) and hepatitis C virus ( HCV ) are at high risk for liver disease progression . However , interferon-based treatments for HCV infection have significant toxicities , limiting treatment uptake . OBJECTIVE To assess the all-oral 3 direct-acting antiviral ( 3D ) regimen of ombitasvir , paritaprevir ( co-dosed with ritonavir [ paritaprevir/r ] ) , dasabuvir , and ribavirin in HCV genotype 1-infected adults with HIV-1 co-infection , including patients with cirrhosis . DESIGN , SETTING , AND PARTICIPANTS TURQUOISE-I is a r and omized , open-label study . Part 1a of this pilot study was conducted at 17 sites in the United States and Puerto Rico between September 2013 and August 2014 and included 63 patients with HCV genotype 1 and HIV-1 co-infection who were HCV treatment-naive or had history of prior treatment failure with peginterferon plus ribavirin therapy . The study allowed enrollment of patients , including those with cirrhosis , with a CD4 + count of 200/mm3 or greater or CD4 + percentage of 14 % or more and plasma HIV-1 RNA suppressed while taking a stable atazanavir- or raltegravir-inclusive antiretroviral regimen . INTERVENTIONS Ombitasvir/paritaprevir/r , dasabuvir , and ribavirin for 12 or 24 weeks of treatment as r and omized . MAIN OUTCOMES AND MEASURES The primary assessment was the proportion of patients with sustained virologic response ( HCV RNA < 25 IU/mL ) at posttreatment week 12 ( SVR12 ) . RESULTS Among patients receiving 12 or 24 weeks of 3D and ribavirin , SVR12 was achieved by 29 of 31 ( 94 % ; 95 % CI , 79%-98 % ) and 29 of 32 patients ( 91 % ; 95 % CI , 76%-97 % ) , respectively . Of the 5 patients who did not achieve SVR , 1 withdrew consent , 2 had confirmed virologic relapse or breakthrough , and 2 patients had clinical history and phylogenetic evidence consistent with HCV reinfection . The most common treatment-emergent adverse events were fatigue ( 48 % ) , insomnia ( 19 % ) , nausea ( 18 % ) , and headache ( 16 % ) . Adverse events were generally mild , with none reported as serious or leading to discontinuation . No patient had a confirmed HIV-1 breakthrough of 200 copies/mL or greater during treatment . CONCLUSIONS AND RELEVANCE In this open-label , r and omized uncontrolled study , treatment with the all-oral , interferon-free 3D-plus-ribavirin regimen result ed in high SVR rates among patients co-infected with HCV genotype 1 and HIV-1 whether treated for 12 or 24 weeks . Further phase 3 studies of this regimen are warranted in patients with co-infection . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01939197 BACKGROUND / AIMS To examine if serum fibrosis biomarkers could accurately identify the stage of liver disease amongst hepatitis C ( HCV ) and HIV co-infected patients . METHODS One hundred and thirty seven HIV/HCV co-infected persons were r and omly selected from the Johns Hopkins HIV Clinic cohort . Ninety five had complete testing for fibrosis markers in sera collected at the time of liver biopsy .  Biopsies were scored according to Ishak modified histological activity index ( F0 no fibrosis to F6 cirrhosis ) . Fibrosis was evaluated against alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , AST to platelet ratio ( APRI ) , albumin , total bilirubin , hyaluronic acid ( HA ) and YKL-40 . RESULTS Sixty nine ( 73 % ) had no or minimal portal fibrosis ( F0 - 2 ) and were compared with remaining subjects ( F3 - 6 ) . Fibrosis scores > or = F3 were found 27 times more often in persons with HA levels > 86 ng/ml and 5.5 times more often in persons with HA levels 41 - 86 ng/ml . Less substantial associations were detected with levels of albumin < 3.5 g/dl ( OR 4.85 ) and AST > 60 iu ( OR 5.91 ) . All 35 subjects who had favorable results of HA , albumin , and AST had minimal fibrosis ( F0 - 2 ) . CONCLUSIONS Amongst HIV/HCV co-infected patients , serum testing for HA , albumin , and AST ( SHASTA Index ) was able to accurately stage mild and advanced fibrosis Liver biopsy remains the gold st and ard in the assessment of severity of liver disease . Noninvasive tests have gained popularity to predict histology in view of the associated risks of biopsy . However , many models include tests not readily available , and there are limited data from patients with HIV/hepatitis C virus ( HCV ) coinfection . We aim ed to develop a model using routine tests to predict liver fibrosis in patients with HIV/HCV coinfection . A retrospective analysis of liver histology was performed in 832 patients . Liver fibrosis was assessed via Ishak score ; patients were categorized as 0 - 1 , 2 - 3 , or 4 - 6 and were r and omly assigned to training ( n = 555 ) or validation ( n = 277 ) sets . Multivariate logistic regression analysis revealed that platelet count ( PLT ) , age , AST , and INR were significantly associated with fibrosis . Additional analysis revealed PLT , age , AST , and ALT as an alternative model . Based on this , a simple index ( FIB-4 ) was developed : age ( [ yr ] x AST [ U/L ] ) / ( ( PLT [ 10(9)/L ] ) x ( ALT [U/L])(1/2 ) ) . The AUROC of the index was 0.765 for differentiation between Ishak stage 0 - 3 and 4 - 6 . At a cutoff of < 1.45 in the validation set , the negative predictive value to exclude advanced fibrosis ( stage 4 - 6 ) was 90 % with a sensitivity of 70 % . A cutoff of > 3.25 had a positive predictive value of 65 % and a specificity of 97 % . Using these cutoffs , 87 % of the 198 patients with FIB-4 values outside 1.45 - 3.25 would be correctly classified , and liver biopsy could be avoided in 71 % of the validation group . In conclusion , noninvasive tests can accurately predict hepatic fibrosis and may reduce the need for liver biopsy in the majority of HIV/HCV-coinfected patients BACKGROUND / AIMS Transient elastometry ( TE ) is accurate for detecting cirrhosis ( F=4 ) in human immunodeficiency virus (HIV)/hepatitis C virus ( HCV ) co-infected patients . However , this procedure is less precise to differentiate mild ( F < or = 1 ) from moderate to severe ( F > or = 2 ) fibrosis using the cut-off value of 7.2kPa , a level previously proposed by some authors . Because of this , we elaborated and vali date d cut-off values of  liver stiffness ( LS ) to better discriminate F < or = 1 from F > or = 2 in HIV/HCV co-infected subjects to aid therapy decisions . METHODS One hundred and ninety-seven co-infected patients with liver biopsy and TE measurement , without prior therapy against HCV infection , were included . RESULTS To diagnose F < or = 2 , a cut-off of 9.0kPa showed a positive predictive value of 87 % . To discard F > or = 2 , a cut-off of 6.0kPa showed a negative predictive value of 90 % . Considering all the patients , 61 ( 31 % ) patients yielded LS values < or = 6.0kPa and 81 ( 41 % ) patients showed LS values > or = 9.0kPa . There were no severe classification errors as the NPV of L < or = S6.0kPa for F > or = 3 
    Output:
    
Transient elastography is a noninvasive imaging modality with excellent ability to assess for cirrhosis in patients with HIV-HCV coinfection