Review for 10.1186/s12876-020-01230-1 (2020)

Reviewer’s report
Title: Causative factors of liver fibrosis in HIV-infected patients. A single center study.
Version: 0 Date: 14 May 2019
Reviewer: Jan-Christian Wasmuth
Reviewer's report:
Androutsakos  et  al.  describe  liver  fibrosis  and  possible  risk  factors  as  assessed  by  transient
elastography in a cohort of 188 HIV-infected patients in a cross-sectional design. 173/187 patients were
classified as no / mild fibrosis, 14/187 as significant fibrosis. Several factors were associated with
fibrosis (Age, AST, HCV , Alcohol, CD4/CD8 Ratio).
My main concern is that no data on antiretroviral Treatment are shown. It has been well described in
recent years that control of HIV-infection is a major protective factor for liver fibrosis and ongoing
viral  replication  is  among  the  strongest  risks  for  fibrosis  (among  others:  Hepatology.  2019
Mar;69(3):1135-1150; PLoS One. 2018 Jan 18;13(1):e0191118). On the other hand, especially older
antiretrovirals are known to be associated with fibrosis (and also other Events like non-cirrhotic Portal
Hypertension).  Therefore it is  essential to Show  Basic data  on (at least current)  ART Treatment
(obviously 85% of patients were treated - reasons for the other 15% not?). Additionally CD4/CD8
Ratio in the year 2017 could be a Surrogate of antiviral Treatment.
I wonder how alcohol-use was assessed and defined. As alcohol would be expected to be the most
important co-factor for fibrosis together with Hepatitis cofinfection, the Reader should be able to
understand how this was done.
188 were included, but fibroscan obtained in 187 - why? Due to design it should not be possible to
include a Patient with no fibroscan available.
ROC analysis is used to illustrate the diagnostic ability of a binary classifier system at different
discrimination thresholds. The purpose of the paper is to analyse possibel factors associated with
fibrosis, not to evaluate a diagnostic tool for liver fibrosis.
Do the authors have any follow-up data? As many cross-sectional data have been presented, longer-
term follow-up would be really interesting.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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