McGill researchers reveal flaw in standard liver-fibrosis screening for HIV patients
A new FIB-HIV scoring method catches cases the widely-used FIB-4 test misses, crucial as aging HIV patients face rising liver-disease risk.
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Researchers at the McGill University Health Centre have exposed a major gap in how liver damage is detected in people living with HIV. The standard FIB-4 blood test, widely used to screen for liver fibrosis — scarring that can lead to permanent damage — incorrectly classified over a third of cases as low-risk, according to a study published in Hepatology.
The problem is particularly severe when fatty liver disease is present. People with HIV and steatotic liver disease who tested low-risk on FIB-4 remained in that category when re-tested months later, meaning they wouldn't get the clinical follow-up they needed.
McGill scientists developed an alternative called FIB-HIV score that factors in metabolic and HIV-specific conditions: obesity, diabetes, high blood pressure, exposure to older antiretroviral drugs, duration of HIV infection, past immune suppression, and viral load. The study tracked nearly 5,000 participants from five countries between 2015 and 2025.
Dr. Giada Sebastiani, an associate professor at McGill and scientist at MUHC, said the research is timely. "In high-income countries, nearly half of all people living with HIV are now over the age of 50," she said. "As this population continues to age, liver disease is becoming an increasingly important health concern."
The research does not yet say when or if hospitals and clinics in Quebec will adopt the new FIB-HIV method instead of FIB-4 screening.
When will Quebec hospitals and clinics switch to the FIB-HIV screening method?
Does FIB-HIV require different or more expensive testing than FIB-4?
We'll update this story as answers emerge.
The facts
What percentage of liver-fibrosis cases did the standard FIB-4 test misclassify as low-risk?
The FIB-4 test incorrectly classified over a third of cases as low-risk, according to a study published in Hepatology by McGill University Health Centre researchers.
What factors does the new FIB-HIV scoring method consider?
The FIB-HIV score factors in obesity, diabetes, high blood pressure, exposure to older antiretroviral drugs, duration of HIV infection, past immune suppression, and viral load.
How many participants were included in the study?
The study tracked nearly 5,000 participants from five countries between 2015 and 2025.
