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Liver Int. 2015 Jul;35(7):1886-92. doi: 10.1111/liv.12780. Epub 2015 Jan 22.

Elevated AST-to-platelet ratio index is associated with increased all-cause mortality among HIV-infected adults in Zambia.

Author information

1
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
2
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
3
Department of Medicine, University of Zambia, Lusaka, Zambia.
4
University Teaching Hospital, Lusaka, Zambia.
5
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
6
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
7
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

BACKGROUND & AIMS:

We investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia.

METHODS:

Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunological status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART.

RESULTS:

Among 20 308 adults in the analysis cohort, 1027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4(+) count <200 cells/mm(3) , and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71-10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21-1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31-1.89) were associated with increased all-cause mortality.

CONCLUSION:

Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings.

KEYWORDS:

AST-to-platelet ratio index; Africa; FIB-4; HIV/AIDS; hepatitis B virus; liver disease

PMID:
25581487
PMCID:
PMC4478217
DOI:
10.1111/liv.12780
[Indexed for MEDLINE]
Free PMC Article

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