HIV/HBV co-infection is a significant risk factor for liver fibrosis in Tanzanian HIV-infected adults

Claudia Hawkins, Beatrice Christian, Emanuel Fabian, Irene Macha, Cecilia Gawile, Shida Mpangala, Nzovu Ulenga, Chloe L Thio, Lauren Rose Ammerman, Ferdinand Mugusi, Wafaie Fawzi, Richard Green, Robert Murphy

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania. METHODS:: Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined. RESULTS:: 267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44% male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95% CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95% CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively. CONCLUSIONS:: HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
StateAccepted/In press - Jun 22 2017

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Coinfection
Liver Cirrhosis
HIV
Blood Platelets
Transaminases
Liver Diseases
Tanzania
Fibrosis
Africa South of the Sahara
Chronic Hepatitis B
Aspartate Aminotransferases

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

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HIV/HBV co-infection is a significant risk factor for liver fibrosis in Tanzanian HIV-infected adults. / Hawkins, Claudia; Christian, Beatrice; Fabian, Emanuel; Macha, Irene; Gawile, Cecilia; Mpangala, Shida; Ulenga, Nzovu; Thio, Chloe L; Rose Ammerman, Lauren; Mugusi, Ferdinand; Fawzi, Wafaie; Green, Richard; Murphy, Robert.

In: Journal of Acquired Immune Deficiency Syndromes, 22.06.2017.

Research output: Contribution to journalArticle

Hawkins, C, Christian, B, Fabian, E, Macha, I, Gawile, C, Mpangala, S, Ulenga, N, Thio, CL, Rose Ammerman, L, Mugusi, F, Fawzi, W, Green, R & Murphy, R 2017, 'HIV/HBV co-infection is a significant risk factor for liver fibrosis in Tanzanian HIV-infected adults', Journal of Acquired Immune Deficiency Syndromes. https://doi.org/10.1097/QAI.0000000000001491
Hawkins, Claudia ; Christian, Beatrice ; Fabian, Emanuel ; Macha, Irene ; Gawile, Cecilia ; Mpangala, Shida ; Ulenga, Nzovu ; Thio, Chloe L ; Rose Ammerman, Lauren ; Mugusi, Ferdinand ; Fawzi, Wafaie ; Green, Richard ; Murphy, Robert. / HIV/HBV co-infection is a significant risk factor for liver fibrosis in Tanzanian HIV-infected adults. In: Journal of Acquired Immune Deficiency Syndromes. 2017.
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abstract = "BACKGROUND:: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania. METHODS:: Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined. RESULTS:: 267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44{\%} male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95{\%} CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95{\%} CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively. CONCLUSIONS:: HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.",
author = "Claudia Hawkins and Beatrice Christian and Emanuel Fabian and Irene Macha and Cecilia Gawile and Shida Mpangala and Nzovu Ulenga and Thio, {Chloe L} and {Rose Ammerman}, Lauren and Ferdinand Mugusi and Wafaie Fawzi and Richard Green and Robert Murphy",
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T1 - HIV/HBV co-infection is a significant risk factor for liver fibrosis in Tanzanian HIV-infected adults

AU - Hawkins, Claudia

AU - Christian, Beatrice

AU - Fabian, Emanuel

AU - Macha, Irene

AU - Gawile, Cecilia

AU - Mpangala, Shida

AU - Ulenga, Nzovu

AU - Thio, Chloe L

AU - Rose Ammerman, Lauren

AU - Mugusi, Ferdinand

AU - Fawzi, Wafaie

AU - Green, Richard

AU - Murphy, Robert

PY - 2017/6/22

Y1 - 2017/6/22

N2 - BACKGROUND:: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania. METHODS:: Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined. RESULTS:: 267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44% male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95% CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95% CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively. CONCLUSIONS:: HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.

AB - BACKGROUND:: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania. METHODS:: Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined. RESULTS:: 267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44% male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95% CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95% CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively. CONCLUSIONS:: HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.

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