Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana

Abstract

People with concomitant human immunodeficiency virus (HIV) and tuberculosis (TB) have an increased risk of hepatotoxic reactions due to antiretroviral therapy (ART) and anti-TB therapy (ATT). Concomitant hepatitis B virus (HBV) in these patients may lead to poorer health outcomes. To assess liver enzyme levels and immune response in adults with HIV, HBV, and TB, data from 300 antiretroviral-naïve people living with HIV (PLWHIV) were analyzed. The prevalence of HIV/HBV (cHIV/HBV) and HIV/TB (cHIV/TB) was 28% (95% CI: 23.0–33.4) and 10% (95% CI: 6.8–14.0), respectively. HIV/HBV/TB (cHIV/HBV/TB) prevalence was 5.3% (95% CI: 3.1–8.5). There was a statistically significant difference between the groups of participants in HIV viral load (p = 0.004), hemoglobin levels (p = 0.025), and body mass index (p = 0.011). A larger proportion of cHIV/HBV/TB participants (37.5%) had an aspartate aminotransferase to platelet ratio index (APRI) score ≥0.5 (p = 0.013), a lower cutoff for significant liver fibrosis. Immunological non-responders (CD4+ T-cell count <20% gain and HIV viral load <400 copies/mL at 6 months) were observed in all groups except those with cHIV/TB. Our findings support the need to screen for infections that could cause excessive liver damage prior to ATT or ART initiation, such as HBV.

FibroScan® versus Biochemical Scores: A Study of Liver Fibrosis in HIV with HBV Co-Infection

“…In HIV patients, liver stiffness increases with advanced AIDS stages, peaking at stage C3. For HIV+HBV patients, higher elastography scores were seen across all stages, suggesting HBV co-infection exacerbates liver disease [ 39 , 40 ]. The highest scores in stage A2 suggest a nonlinear relationship between liver stiffness and AIDS stages in co-infected patients.…”

“…HIV can impair the immune system, making it more difficult to respond to HBV infection and potentially increasing the risk of chronicity. Both viruses can directly affect liver cells, with HIV enhancing fibrogenesis and HBV leading to cell death and regeneration in chronic infections [ 39 ]. Some antiretroviral drugs used to treat HIV have hepatotoxic potential and may cause more damage to the liver in the presence of HBV [ 39 , 40 ].…”

“…Both viruses can directly affect liver cells, with HIV enhancing fibrogenesis and HBV leading to cell death and regeneration in chronic infections [ 39 ]. Some antiretroviral drugs used to treat HIV have hepatotoxic potential and may cause more damage to the liver in the presence of HBV [ 39 , 40 ]. Additionally, when patients initiate ART to treat HIV, they may experience an inflammatory response as the immune system recovers (immune reconstitution inflammatory syndrome), which can worsen liver inflammation in the presence of underlying HBV infection.…”

Prevalence of Hepatitis B Virus Mutations Associated with Hepatocellular Carcinoma in HBV and HIV Co-infected Adults in Botswana

“…Studies have reported HBV prevalence and drug resistance mutations among different populations in Botswana [6,[28][29][30][31][32][33][34], but no study has determined the prevalence of HCC-associated HBV mutations in HBV/HIV co-infection. Therefore, we sought to determine the prevalence of the known HCC-associated mutations among HBV/HIV co-infected individuals in Botswana, as well as their association with markers of HBV disease progression.…”