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Int J Infect Dis. 2016 Oct;51:97-102. doi: 10.1016/j.ijid.2016.08.028. Epub 2016 Sep 3.

Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared.

Author information

1
Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. Electronic address: gilles.wandeler@ispm.unibe.ch.
2
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Medicine, University of Zambia, Lusaka, Zambia.
3
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
4
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
5
University Hospital Basel, Basel, Switzerland.
6
University Hospital Geneva, Geneva, Switzerland.
7
University Hospital Lausanne, Lausanne, Switzerland.
8
Regional Hospital, Lugano, Switzerland.
9
Cantonal Hospital, St. Gallen, Switzerland.
10
Department of Medicine, University of Zambia, Lusaka, Zambia.
11
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
12
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
13
Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland.

Abstract

OBJECTIVE:

To examine the association between hepatitis B virus (HBV) infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland.

METHODS:

HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland were included. Liver fibrosis was evaluated using the aspartate aminotransferase-to-platelet-ratio index (APRI), with a ratio >1.5 defining significant fibrosis and a ratio >2.0 indicating cirrhosis. The association between hepatitis B surface antigen (HBsAg) positivity, HBV replication, and liver fibrosis was examined using logistic regression.

RESULTS:

In Zambia, 96 (13.0%) of 739 patients were HBsAg-positive compared to 93 (4.5%) of 2058 in Switzerland. HBsAg-positive patients were more likely to have significant liver fibrosis than HBsAg-negative ones: the adjusted odds ratio (aOR) was 3.25 (95% confidence interval (CI) 1.44-7.33) in Zambia and 2.50 (95% CI 1.19-5.25) in Switzerland. Patients with a high HBV viral load (≥20000 IU/ml) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with an undetectable viral load: aOR 3.85 (95% CI 1.29-11.44) in Zambia and 4.20 (95% CI 1.64-10.76) in Switzerland. In both settings, male sex was a strong risk factor for significant liver fibrosis.

CONCLUSIONS:

Despite the differences in HBV natural history between Sub-Saharan Africa and Europe, the degree of liver fibrosis and the association with important risk factors were similar.

KEYWORDS:

HIV; Hepatitis B infection; Liver fibrosis; Switzerland; Zambia

PMID:
27596685
PMCID:
PMC5363287
DOI:
10.1016/j.ijid.2016.08.028
[Indexed for MEDLINE]
Free PMC Article

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