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. 2016 Oct:51:97-102.
doi: 10.1016/j.ijid.2016.08.028. Epub 2016 Sep 3.

Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared

Gilles Wandeler  1 , Lloyd Mulenga  2 , Michael J Vinikoor  3 , Helen Kovari  4 , Manuel Battegay  5 , Alexandra Calmy  6 , Matthias Cavassini  7 , Enos Bernasconi  8 , Patrick Schmid  9 , Carolyn Bolton-Moore  3 , Edford Sinkala  10 , Benjamin H Chi  11 , Matthias Egger  12 , Andri Rauch  13 ; for IeDEA-Southern Africa and the Swiss HIV Cohort Study
Affiliations

Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared

Gilles Wandeler et al. Int J Infect Dis. 2016 Oct.

Abstract

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 (≥20000 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.

Keywords: HIV; Hepatitis B infection; Liver fibrosis; Switzerland; Zambia.

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Figures

Figure 1
Figure 1
Proportion of patients with significant fibrosis (A) and cirrhosis (B), by country and HBV status
Figure 2
Figure 2
Risk factors for significant liver fibrosis (APRI>=1.5) from multivariable logistic regression, by cohort
Figure 3
Figure 3
Proportion of patients with significant fibrosis, by country and HBV replication status
See this image and copyright information in PMC

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