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. 2016 Jun 7:6:22.
doi: 10.4103/2156-7514.183582. eCollection 2016.

High Prevalence of Liver Fibrosis in Patients with Human Immunodeficiency Virus Monoinfection and Human Immunodeficiency Virus Hepatitis-B Co-infection as Assessed by Shear Wave Elastography: Study at a Teaching Hospital in Kenya

Samuel Nguku Gitau  1 , Sudhir Vinayak  1 , Micah Silaba  1 , Rodney Adam  2 , Reena Shah  2
Affiliations

High Prevalence of Liver Fibrosis in Patients with Human Immunodeficiency Virus Monoinfection and Human Immunodeficiency Virus Hepatitis-B Co-infection as Assessed by Shear Wave Elastography: Study at a Teaching Hospital in Kenya

Samuel Nguku Gitau et al. J Clin Imaging Sci. .

Abstract

Objectives: The aim of this study was to determine the prevalence of liver fibrosis in patients with human immunodeficiency virus (HIV) monoinfection versus those with HIV hepatitis-B virus (HBV) co-infection as assessed with shear wave elastography (SWE) in a tertiary sub-Saharan Africa hospital.

Materials and methods: A total of 105 consecutive patients, 70 with HIV monoinfection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for the presence of liver fibrosis the cutoff of which was 5.6 kPa. Assessment of aspartate aminotransferase-to-platelet ratio index (APRI) score (a noninvasive serum biomarker of liver fibrosis) in these patients was also done.

Results: The prevalence of liver fibrosis was significantly higher (P < 0.0001) in patients with HIV-HBV co-infection, 25.7%, compared to those with HIV monoinfection, 7.1%. APRI score was greater in patients with HIV-HBV co-infection than those with HIV monoinfection. HIV co-infection with HBV accelerates progression to liver fibrosis. Association of a low cluster of differentiation 4 (CD-4) count with advanced fibrosis supports earlier starting of antiretroviral therapy to prevent rapid progression of liver disease in HIV-positive patients.

Conclusion: In view of the high prevalence of liver fibrosis in patients with HIV-HBV co-infection, regular monitoring of the disease progression is recommended.

Keywords: Hepatitis-B; Human immunodeficiency virus; liver fibrosis; shear wave elastography.

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Figures

Figure 1
Figure 1
Flow chart showing process of recruitment of patients.
Figure 2
Figure 2
43-year-old male with human immunodeficiency virus monoinfection (a) Grayscale liver ultrasound image shows acquisition of liver stiffness measurement using shear wave elastography. The sample box (arrow) is away from the liver capsule and large blood vessels. (b) A table shows summary of ten liver stiffness measurement readings of the same patient with a median elastography score (encircled) of 2.75 kPa.
Figure 3
Figure 3
A 39-year-old male with the human immunodeficiency virus hepatitis-B virus co-infection (a) Grayscale ultrasound image of the liver shows a shear wave elastography acquisition box (arrow) with a high elastography score of 7.4 kPa. (b) A table showing ten liver stiffness measurements readings for the same patient with a high median elastography score of 6.35 kPa (encircled).
Figure 4
Figure 4
Bar graph comparing prevalence of liver fibrosis in the human immunodeficiency virus- monoinfected and human immunodeficiency virus hepatitis-B virus co-infected patients show a higher prevalence in the co-infected group of approximately 26%.
Figure 5
Figure 5
Bar graph shows distribution of aspartate aminotransferase-to-platelet ratio index score in the human immunodeficiency -virus monoinfected and human immunodeficiency virus hepatitis-B virus co-infected groups and indicates that only the co-infected group had patients with an aspartate aminotransferase-to-platelet ratio index score above 1.5.
Figure 6
Figure 6
A scatter plot between median elastography scores and aspartate aminotransferase-to-platelet ratio index scores with a fitted linear regression line. There was a better correlation between the two for patients with aspartate aminotransferase-to-platelet ratio index score less than 0.5 as opposed to those with higher scores.
See this image and copyright information in PMC

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