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. 2017 May 15;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

Michael J Vinikoor  1   2   3 , Edford Sinkala  3   4 , Roma Chilengi  2 , Lloyd B Mulenga  3   4 , Benjamin H Chi  5 , Zude Zyambo  2 , Christopher J Hoffmann  6 , Michael S Saag  1 , Mary-Ann Davies  7 , Matthias Egger  8 , Gilles Wandeler  8   9 ; IeDEA- Southern Africa
Affiliations

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

Michael J Vinikoor et al. Clin Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2017 Oct 15;65(8):1431-1433. doi: 10.1093/cid/cix563. Clin Infect Dis. 2017. PMID: 29017252 Free PMC article. No abstract available.

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.

Clinical trials registration: NCT02060162.

Keywords: Africa; HIV/AIDS; hepatitis B virus; liver fibrosis; transient elastography..

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Figures

Figure 1.
Figure 1.
Cohort flow diagram. Abbreviations: ART, antiretroviral therapy; HBV, hepatitis B virus; HIV, human immunodeficiency virus; LTFU, lost to follow-up; TE, transient elastography.
Figure 2.
Figure 2.
Change in liver stiffness during the initial year of antiretroviral therapy among human immunodeficiency virus–infected adults in Zambia, by hepatitis B virus coinfection status. Abbreviations: HBV, hepatitis B virus; HIV, human immunodeficiency virus.
Figure 3.
Figure 3.
Association between human immunodeficiency virus (HIV) and hepatitis B virus (HBV) viral suppression at 1 year on antiretroviral therapy among HIV–HBV-coinfected adults. Abbreviation: HIV, human immunodeficiency virus.
See this image and copyright information in PMC

References

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