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: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1343-1349
Number of pages7
JournalClinical Infectious Diseases
Volume64
Issue number10
DOIs
StatePublished - May 15 2017

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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  • Cite this

    Vinikoor, M. J., Sinkala, E., Chilengi, R., Mulenga, L. B., Chi, B. H., Zyambo, Z., Hoffmann, C. J., Saag, M. S., Davies, M. A., 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, 64(10), 1343-1349. https://doi.org/10.1093/cid/cix122