Sterling RK, et al. - As non-invasive biomarkers are increasingly being used to evaluate fibrosis in patients with chronic liver disease, researchers assessed patients co-infected with HBV-HIV receiving combined anti-retroviral therapy (CART) to see if dual cut-offs for non-invasive biomarkers are useful to exclude and confirm advanced fibrosis. Study participants included anti-HIV/HBsAg positive adults from eight clinical sites in the United States and Canada of the Hepatitis B Research Network. Using established methodology, dual cut-offs for three non-invasive biomarkers (APRI, FIB-4 and liver stiffness by vibration-controlled transient elastography [VCTE]) with the best accuracy to exclude or confirm advanced fibrosis (F ≥3) were determined. According to results, VCTE cut-offs of ≤5.0 kPa (to exclude) and ≥8.8 kPa (to confirm) advanced fibrosis had a 92.3% sensitivity and 96.0% specificity, respectively, and accounted for 65.1% of participants. In HBV/HIV co-infected adults on cART, VCTE is superior to APRI or FIB-4 as a biomarker of advanced fibrosis. Around two-thirds of patients may be able to evade biopsy using VCTE dual cut-offs to determine advanced fibrosis.