Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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..

PubMed Disclaimer

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

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Data Collection on Adverse Events of Anti-HIV Drugs Study Group. Liver-related deaths in persons infected with the human immunodeficiency virus: the D: A: D study. Arch Intern Med 2006; 166:1632. - PubMed
    1. Redd AD, Wendel SK, Grabowski MK, et al. Liver stiffness is associated with monocyte activation in HIV-infected Ugandans without viral hepatitis. AIDS Res Hum Retroviruses 2013; 29:1026–30. - PMC - PubMed
    1. Grant J, Agbaji O, Muhammad M, et al. Long-term changes in liver fibrosis in HIV and HIV/HBV infected Nigerians on ART. Boston, MA: Conference on Retroviruses and Opportunistic Infections, IAS-USA, 2016.
    1. Tuyama AC, Hong F, Saiman Y, et al. Human immunodeficiency virus (HIV)-1 infects human hepatic stellate cells and promotes collagen I and monocyte chemoattractant protein-1 expression: implications for the pathogenesis of HIV/hepatitis C virus-induced liver fibrosis. Hepatology 2010; 52:612–22. - PMC - PubMed
    1. Kim HN, Nance R, Van Rompaey S, et al. Poorly controlled HIV infection: an independent risk factor for liver fibrosis. J Acquir Immune Defic Syndr 2016; 72:437–43. - PMC - PubMed

MeSH terms

Associated data