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

Abstract

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.

Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China

“…Obviously, these studies observed varied prevalence of liver fibrosis among HIV patients, which are mostly attributable to different sources and characteristics of the study participants. Nevertheless, all the aforementioned studies including the present study reported that liver fibrosis was more prevalent among patients with HBV and/or HCV coinfection than those with HIV monoinfection, which is also consistent with findings from other countries (22,(29)(30)(31).…”

HBV and HIV viral load but not microbial translocation or immune activation are associated with liver fibrosis among patients in South Africa

“…The relationship of active viral replication with fibrosis implicates active antigen-specific anti-viral responses as being important to pathogenesis of liver fibrosis. Viral replication as the driver of liver fibrosis has been reported among treatment-naïve HBV/HIV co-infected patients in Zambia and Switzerland [ 47 ].…”

Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

“…It is also possible that this practice is influenced by a greater perceived risk of developing inflammatory liver conditions in coinfected patients. 49 Amongst the coinfected group, who were more likely to have undergone assessment, 10% of individuals were nevertheless still lacking elastography results. We were unable to determine specific treatment duration for a proportion of the patients studied, adding to uncertainty about exposure to antiviral therapy in HBV and HBV/HIV infected groups.…”