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Clin Infect Dis. 2017 May 15;64(10):1343-1349. doi: 10.1093/cid/cix122.

Impact of Antiretroviral Therapy on Liver Fibrosis Among Human Immunodeficiency Virus-Infected Adults With and Without HBV Coinfection in Zambia.

Author information

1
Department of Medicine, University of Alabama at Birmingham.
2
Centre for Infectious Disease Research in Zambia.
3
School of Medicine, University of Zambia, and.
4
Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
5
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill.
6
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
7
School of Public Health and Family Medicine, University of Cape Town, South Africa.
8
Institute of Social and Preventive Medicine, University of Bern, Switzerland.
9
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.

Abstract

Background:

We investigated changes in hepatic fibrosis, based on transient elastography (TE), among human immunodeficiency virus (HIV)-infected patients with and without hepatitis B virus (HBV) coinfection on antiretroviral therapy (ART) in Zambia.

Methods:

Patients' liver stiffness measurements (LSM; kiloPascals [kPa]) at ART initiation were categorized as no or minimal fibrosis (equivalent to Metavir F0-F1), significant fibrosis (F2-F3), and cirrhosis (F4). TE was repeated following 1 year of ART. Stratified by HBV coinfection status (hepatitis B surface antigen positive at baseline), we described LSM change and the proportion with an increase/decrease in fibrosis category. Using multivariable logistic regression, we assessed correlates of significant fibrosis/cirrhosis at 1 year on ART.

Results:

Among 463 patients analyzed (61 with HBV coinfection), median age was 35 years, 53.7% were women, and median baseline CD4+ count was 240 cells/mm3. Nearly all (97.6%) patients received tenofovir disoproxil fumarate-containing ART, in line with nationally recommended first-line treatment. The median LSM change was -0.70 kPa (95% confidence interval, -3.0 to +1.7) and was similar with and without HBV coinfection. Significant fibrosis/cirrhosis decreased in frequency from 14.0% to 6.7% (P < .001). Increased age, male sex, and HBV coinfection predicted significant fibrosis/cirrhosis at 1 year (all P < .05).

Conclusion:

The percentage of HIV-infected Zambian adults with elevated liver stiffness suggestive of significant fibrosis/cirrhosis decreased following ART initiation-regardless of HBV status. This suggests that HIV infection plays a role in liver inflammation. HBV-coinfected patients were more likely to have significant fibrosis/cirrhosis at 1 year on ART.

Clinical Trials Registration:

NCT02060162.

KEYWORDS:

Africa; HIV/AIDS; hepatitis B virus; liver fibrosis; transient elastography.

PMID:
28158504
PMCID:
PMC5411400
DOI:
10.1093/cid/cix122
[Indexed for MEDLINE]
Free PMC Article

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