Association between hepatitis B co‐infection and elevated liver stiffness among HIV‐infected adults in Lusaka, Zambia. Issue 11 (30th August 2016)

• Record Type: Journal Article
• Authors: Vinikoor, Michael J.; Mulenga, Lloyd; Siyunda, Alice; Musukuma, Kalo; Chilengi, Roma; Moore, Carolyn Bolton; Chi, Benjamin H.; Davies, Mary‐Ann; Egger, Matthias; Wandeler, Gilles
• Is Part Of: Tropical medicine & international health. Volume 21:Issue 11(2016)
• Page Start: 1435
• Page End: 1441
• Publication Date: 2016-08-30
• Subjects: HIV/AIDS -- Africa -- liver fibrosis -- hepatitis B virus -- transient elastography -- alcohol use disorder; VIH/SIDA -- Afrique -- fibrose hépatique -- virus de l'hépatite B -- élastographie transitoire -- trouble de la consommation d'alcool; VIH/SIDA -- África -- fibrosis hepática -- virus hepatitis B -- elastografía transitoria -- alcoholismo; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12764
• Languages: English
• ISSNs: 1360-2276

Abstract

Abstract: Objective: To describe liver disease epidemiology among HIV‐infected individuals in Zambia. Methods: We recruited HIV‐infected adults (≥18 years) at antiretroviral therapy initiation at two facilities in Lusaka. Using vibration controlled transient elastography, we assessed liver stiffness, a surrogate for fibrosis/cirrhosis, and analysed liver stiffness measurements (LSM) according to established thresholds (>7.0 kPa for significant fibrosis and >11.0 kPa for cirrhosis). All participants underwent standardised screening for potential causes of liver disease including chronic hepatitis B (HBV) and C virus co‐infection, herbal medicine, and alcohol use. We used multivariable logistic regression to identify factors associated with elevated liver stiffness. Results: Among 798 HIV‐infected patients, 651 had a valid LSM (median age, 34 years; 53% female). HBV co‐infection (12%) and alcohol use disorders (41%) were common and hepatitis C virus co‐infection (<1%) was rare. According to LSM, 75 (12%) had significant fibrosis and 13 (2%) had cirrhosis. In multivariable analysis, HBV co‐infection as well as male sex, increased age and WHO clinical stage 3 or 4 were independently associated with LSM >7.0 kPa (all P < 0.05). HBV co‐infection was the only independent risk factor for LSM >11.0 kPa. Among HIV–HBV patients, those with elevated ALT and HBV viral load were more likely to have significant liver fibrosis than patients with normal markers of HBV activity. Conclusions: HBV co‐infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimise treatment outcomes.