Assessment of Liver Fibrosis by Transient Elastography in Patients With HIV and Hepatitis B Virus Coinfection in Nigeria

Hawkins, Claudia; Agbaji, Oche; Ugoagwu, Placid; Thio, Chloe L.; Auwal, Muazu; Ani, Charles Chibunna; Okafo, Chinedum; Wallender, Erika; Murphy, Robert L.

doi:10.1093/cid/cit564

Cited by 33 publications

(47 citation statements)

References 11 publications

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“…Although APRI and FIB-4 may be less sensitive for the detection of fibrosis and cirrhosis compared to other measures such as TE [13], our data is consistent with other studies of liver fibrosis in HIV and HBV infected populations in SSA, where more expensive fibrosis measures have been used [9, 14]. Thus, findings in our study would support the use of APRI and FIB-4 in these settings.…”

Section: Discussionsupporting

confidence: 90%

Brief Report: HIV/HBV Coinfection is a Significant Risk Factor for Liver Fibrosis in Tanzanian HIV-Infected Adults

Hawkins

Christian

Fabian

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania. Methods Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined. Results 267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44% male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95% CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95% CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively. Conclusions HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.

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Section: Discussionsupporting

confidence: 90%

Brief Report: HIV/HBV Coinfection is a Significant Risk Factor for Liver Fibrosis in Tanzanian HIV-Infected Adults

Hawkins

Christian

Fabian

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The Multicenter AIDS Cohort Study (MACS) showed a strong association between viral hepatitis coinfection and significant liver fibrosis using the APRI score, but the number of HBV-infected patients analyzed was small (19). In SSA, two studies based on transient elastography measurements showed conflicting results: Hawkins et al reported a strong association between HBV-coinfection and liver fibrosis in HIV-infected individuals in Nigeria, whereas Stabinski et al found no such association in a large cohort in Uganda (4, 23). …”

Section: Discussionmentioning

confidence: 99%

“…HIV infection accelerates the progression of HBV-related liver fibrosis, especially if cellular immunity is impaired or in the absence of adequate treatment of HBV infection (3). A recent study from Nigeria showed that HIV/HBV-coinfected individuals were five times more likely to have advanced liver fibrosis compared to HIV-monoinfected people (4). Although the mechanisms of HBV-related fibrogenesis are not fully understood, recent results from prospective cohorts in Europe, North America and Asia have provided new insights to its main determinants (5).…”

Section: Introductionmentioning

confidence: 99%

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

Wandeler

Mulenga

Vinikoor

et al. 2016

International Journal of Infectious Diseases

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Objective To examine the association between HBV infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland. Design and Methods We included HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland. Liver fibrosis was evaluated using the AST-to-Platelet-Ratio Index (APRI), with a ratio >1.5 defining significant fibrosis and >2.0 cirrhosis. The association between 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 2,058 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% CI 1.44-7.33) in Zambia and 2.50 (1.19-5.25) in Switzerland. Patients with high HBV viral load (≥20,000 UI/mL) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with undetectable viral load: aOR 3.85 (1.29-11.44) in Zambia and 4.20 (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.

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“…A previous report have identified PLWHIV as vulnerable to liver fibrosis in a context of no or limited access to ART in Uganda [9]. The association between HBV infection and liver fibrosis has been previously reported among PLWHIV in Nigeria [10]. Aside HBV infection, there are limited information on other risk factors of liver fibrosis among African PLWHIV.…”

Section: Introductionmentioning

confidence: 99%

Alcohol use, viral hepatitis and liver fibrosis among HIV‐positive persons in West Africa: a cross‐sectional study

Jaquet

Wandeler

Nouaman

et al. 2017

Journal of the International AIDS Society

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Introduction: Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. However, little is known about liver fibrosis and its correlates among PLWHIV in sub-Saharan Africa. Methods: The study was undertaken in three HIV referral clinics in Côte d’Ivoire, Senegal and Togo. Enrolled PLWHIV underwent a non-invasive assessment of liver fibrosis combining liver stiffness measure (LSM) with transient elastography and the aspartate aminotransferase-to-platelet ratio index (APRI). Significant liver fibrosis was defined as LSM ≥7.1 kPa. Patients were screened for alcohol use (alcohol use disorder identification test (AUDIT)-C questionnaire), hepatitis B virus (HBV) antigen, hepatitis Delta virus (HDV) antibody and anti-hepatitis C (HCV) antibody. A logistic regression model was used to identify the factors associated with significant liver fibrosis. Results: A total of 807 PLWHIV were screened at a median age of 43 years (interquartile range (IQR): 36–50). Their median CD4 count was 393 cells/mm3 (IQR: 234–563) and 682 (84.5%) were on antiretroviral therapy (ART). The prevalence of significant fibrosis was 5.3% (3.8–6.7). Infections with HBV and HCV were identified in 74 (9.2%) and nine (1.1%) participants. Main factors associated with liver fibrosis were alcohol use (AUDIT-C >6): (odds ratio (OR) = 4.0, confidence interval (CI): 1.2–14.0), (Ref. AUDIT-C <4) and HBV infection (OR = 2.9, CI: 1.2–7.2). Of the 74 patients positively screened for HBV, 50.0% were on a tenofovir-based ART regimen. Overall, 10% of HIV/HBV coinfected patients were detected with a positive HDV antibody with a higher prevalence in patients with a significant liver fibrosis (43.0%) compared to others (6.3%) (p = 0.01). Conclusions: Considering the WHO recommendations to screen for HBV infection and treat co-infected patients with tenofovir-based ART, screening of alcohol use and brief interventions to prevent alcohol abuse should be implemented in West Africa, especially in HBV/HIV co-infected patients.

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Assessment of Liver Fibrosis by Transient Elastography in Patients With HIV and Hepatitis B Virus Coinfection in Nigeria

Cited by 33 publications

References 11 publications

Brief Report: HIV/HBV Coinfection is a Significant Risk Factor for Liver Fibrosis in Tanzanian HIV-Infected Adults

Brief Report: HIV/HBV Coinfection is a Significant Risk Factor for Liver Fibrosis in Tanzanian HIV-Infected Adults

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

Alcohol use, viral hepatitis and liver fibrosis among HIV‐positive persons in West Africa: a cross‐sectional study

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