Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared. (October 2016)

• Record Type: Journal Article
• Authors: Wandeler, Gilles; Mulenga, Lloyd; Vinikoor, Michael J.; Kovari, Helen; Battegay, Manuel; Calmy, Alexandra; Cavassini, Matthias; Bernasconi, Enos; Schmid, Patrick; Bolton-Moore, Carolyn; Sinkala, Edford; Chi, Benjamin H.; Egger, Matthias; Rauch, Andri
• Is Part Of: International journal of infectious diseases. Volume 51(2016:Oct.)
• Page Start: 97
• Page End: 102
• Publication Date: 2016-10
• Subjects: Hepatitis B infection -- HIV -- Liver fibrosis -- Switzerland -- Zambia; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2016.08.028
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: This was a cross-sectional study of HIV-infected, antiretroviral therapy-naïve adults in Zambia and Switzerland. HIV/hepatitis B virus (HBV) co-infected patients are at least three times more likely to have significant liver fibrosis compared to HIV monoinfected individuals. The association between HBV and liver fibrosis seems to be driven by HBV viral load. The main risk factors for liver fibrosis are similar in Switzerland and Zambia. Summary: 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 (≥20 000 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.