Impact of Antiretroviral Therapy on Liver Fibrosis among Human Immunodeficiency Virus-Infected Adults with and Without HBV Coinfection in Zambia

Michael J. Vinikoor, Edford Sinkala, Roma Chilengi, Lloyd B. Mulenga, Benjamin H. Chi, Zude Zyambo, Christopher J. Hoffmann, Michael S. Saag, Mary Ann Davies, Matthias Egger, Gilles Wandeler

Research output: Research - peer-reviewArticle

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.

LanguageEnglish (US)
Pages1343-1349
Number of pages7
JournalClinical Infectious Diseases
Volume64
Issue number10
DOIs
StatePublished - May 15 2017

Fingerprint

Zambia
Coinfection
Hepatitis B virus
Liver Cirrhosis
Fibrosis
HIV
Therapeutics
Liver
Elasticity Imaging Techniques
Tenofovir
Virus Diseases
CD4 Lymphocyte Count
Hepatitis B Surface Antigens
Logistic Models
Confidence Intervals
Inflammation

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Vinikoor, M. J., Sinkala, E., Chilengi, R., Mulenga, L. B., Chi, B. H., Zyambo, Z., ... Wandeler, G. (2017). Impact of Antiretroviral Therapy on Liver Fibrosis among Human Immunodeficiency Virus-Infected Adults with and Without HBV Coinfection in Zambia. Clinical Infectious Diseases, 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. / Vinikoor, Michael J.; Sinkala, Edford; Chilengi, Roma; Mulenga, Lloyd B.; Chi, Benjamin H.; Zyambo, Zude; Hoffmann, Christopher J.; Saag, Michael S.; Davies, Mary Ann; Egger, Matthias; Wandeler, Gilles.

In: Clinical Infectious Diseases, Vol. 64, No. 10, 15.05.2017, p. 1343-1349.

Research output: Research - peer-reviewArticle

Vinikoor, MJ, Sinkala, E, Chilengi, R, Mulenga, LB, Chi, BH, Zyambo, Z, Hoffmann, CJ, Saag, MS, Davies, MA, Egger, M & Wandeler, G 2017, 'Impact of Antiretroviral Therapy on Liver Fibrosis among Human Immunodeficiency Virus-Infected Adults with and Without HBV Coinfection in Zambia' Clinical Infectious Diseases, vol 64, no. 10, pp. 1343-1349. DOI: 10.1093/cid/cix122
Vinikoor MJ, Sinkala E, Chilengi R, Mulenga LB, Chi BH, Zyambo Z et al. Impact of Antiretroviral Therapy on Liver Fibrosis among Human Immunodeficiency Virus-Infected Adults with and Without HBV Coinfection in Zambia. Clinical Infectious Diseases. 2017 May 15;64(10):1343-1349. Available from, DOI: 10.1093/cid/cix122
Vinikoor, Michael J. ; Sinkala, Edford ; Chilengi, Roma ; Mulenga, Lloyd B. ; Chi, Benjamin H. ; Zyambo, Zude ; Hoffmann, Christopher J. ; Saag, Michael S. ; Davies, Mary Ann ; Egger, Matthias ; Wandeler, Gilles. / Impact of Antiretroviral Therapy on Liver Fibrosis among Human Immunodeficiency Virus-Infected Adults with and Without HBV Coinfection in Zambia. In: Clinical Infectious Diseases. 2017 ; Vol. 64, No. 10. pp. 1343-1349
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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.",
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AU - Mulenga,Lloyd B.

AU - Chi,Benjamin H.

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