Tuberculosis and Hepatic Steatosis Are Prevalent Liver Pathology Findings among HIV-Infected Patients in South Africa

Hoffmann, Christopher J.; Hoffmann, Jennifer; Kensler, Caroline; Watt, Martin van der; Touzani, Omar; Chaisson, Richard E.; Martinson, Neil; Variava, Ebrahim

doi:10.1371/journal.pone.0117813

Cited by 16 publications

(11 citation statements)

References 25 publications

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“…Subgroup analysis was done to find heterogeneity based on age, types of EPTB, study design, subregion of SSA, and countries having two or more studies and the time variation. For instance, by study population age group, inconsistency of the estimate was not removed, the EPTB among PLWHA did not vary by age group when we compared children <15 years, 23 , 28 , 39 adults ≥15 years 11 , 21 , 46 or ≥18 years 25 , 29 , 33 and all age groups in remaining 21 studies ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis

Mohammed

Assefa

Mengistie

2018

HIV

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BackgroundThe double burden of infectious diseases such as tuberculosis (TB) and HIV disproportionately affects Africa. Our objective was to summarize the prevalence of extrapulmonary TB (EPTB) among people living with HIV/AIDS (PLWHA) in sub-Saharan Africa (SSA).MethodsWe searched PubMed and Google Scholar for studies done on the prevalence of EPTB among PLWHA which published in English from 1990 to 2017. We also searched bibliographic indices and browsed through reference lists of articles and journals. We critically appraised the quality of articles and abstracted the data with Joanna Briggs Institute (JBI) checklists. We used Review Manager Software (version 5.3) and Compressive Meta-analysis Software (version 2.2) for analysis. Finally, we summarized the effect estimate by using random-effects model and explored potential sources of heterogeneity by subgroup and sensitivity analyses. We assessed publication bias by funnel plot and statistical test. Finally, we used PRISMA format for reporting.ResultsWe included, in this review, 31 studies that fulfilled our inclusion criteria, with a total population of 28,659. The prevalence estimate of EPTB among PLWHA ranged from 6.4% (95% CI: 3.8, 9.0) to 36.8% (95% CI: 28.6, 45); random-effects pooled prevalence of EPTB among PLWHA was found to be 20% (95% CI: 17, 22; heterogeneity: τ2=0; χ2=509.09, degrees of freedom [df]=30, P<0.00001; I2=94%). No evidence of publication bias was observed (P=0.44 for Egger’s regression analysis and P=0.11 for Begg’s rank correlation analysis).ConclusionWe can conclude from our analyses that the prevalence of EPTB among PLWHA was high. It is necessary to give emphasis for EPTB, especially when screening TB among PLWHA, widening the spectrum of screening to include all EPTB sites in the countries with high EPTB and/or HIV prevalence in the general population.

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Section: Resultsmentioning

confidence: 99%

Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis

Mohammed

Assefa

Mengistie

2018

HIV

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“…Currently there is a paucity of data on fatty liver in SSA, although the prevalence of obesity, dyslipidaemia and metabolic disorders such as diabetes is significantly increasing. 26,27 This study provides some of the first long-term data on liver fibrosis changes in this setting, and is unique because of the longer duration of follow-up and the interval between TE measurement than other studies. One limitation of this study is the lack of complete TE data at follow-up, which could have resulted in biased selection of the healthiest individuals in our analysis of the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

Grant

Agaba

Ugoagwu

et al. 2019

Journal of Antimicrobial Chemotherapy

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Background There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- and HIV/HBV-infected individuals. Objectives To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- and HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods We included ART-naive HIV- and HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cut-offs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We used multivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results A total of 106 HIV- and 71 HIV/HBV-infected patients [70.5% female and median age = 34 years (IQR = 29–42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV- versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P < 0.01); LSM scores at year 3 were not significantly different between HIV- and HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4+ T cells ≥200 (versus <200) cells/mm3 and lower BMIs were more likely to experience LSM stage decline. Conclusions HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

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“…Prevalence estimates for hepatic steatosis among HIV+ persons have varied widely, ranging from 13 to 72% [5–13]. Cross-sectional studies evaluating the association between HIV and hepatic steatosis have produced varying results, with some reporting a positive association [6, 7, 12], negative association [5, 8, 11], or no association [10, 13]. These disparate findings may be a result of the different modalities employed to measure hepatic steatosis and the differing sensitivity and specificity of such methods.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people

et al. 2019

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Background Hepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection. We compared the prevalence and severity of hepatic steatosis between HIV-infected (HIV+) and uninfected persons and identified factors associated with greater steatosis severity within both groups. Methods We performed a cross-sectional study among participants without cardiovascular disease who participated in a substudy of the Veterans Aging Cohort Study. Hepatic steatosis was defined by noncontrast computed tomography (CT) liver-to-spleen (L/S) attenuation ratio < 1.0. Multivariable linear regression was used to: 1) evaluate the association between HIV infection and severity of hepatic steatosis, as measured by absolute liver attenuation, and 2) identify factors associated with greater severity of steatosis, by HIV status. Results Among 268 participants (median age, 55 years; 99% male; 79% black; 23% obese; 64% HIV+ [91% on antiretroviral therapy]), the overall prevalence of steatosis was 7.8% and was similar between HIV+ and uninfected individuals (13 [7.6%] versus 8 [8.2%], respectively; p = 0.85). Participants with HIV, the majority of whom received antiretroviral therapy, had a higher mean absolute liver attenuation (mean difference, 5.68 Hounsfield units; p < 0.001), correlating with lesser hepatic steatosis severity, compared to uninfected participants. After adjusting for covariates, only advanced hepatic fibrosis was associated with greater severity of steatosis in HIV+ persons ( p = 0.03) and uninfected individuals ( p < 0.001). Conclusions In this sample of participants without cardiovascular disease, the prevalence of hepatic steatosis by noncontrast abdominal CT was not different by HIV status. Increasing severity of steatosis was independently associated with advanced hepatic fibrosis in both groups. Electronic supplementary material The online version of this article (10.1186/s12876-019-0969-1) contains supplementary material, which is available to authorized users.

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Tuberculosis and Hepatic Steatosis Are Prevalent Liver Pathology Findings among HIV-Infected Patients in South Africa

Cited by 16 publications

References 25 publications

Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis

Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis

Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people

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