Claudia Hawkins1, Beatrice Christian, Emanuel Fabian, Irene Macha, Cecilia Gawile, Shida Mpangala, Nzovu Ulenga, Chloe L Thio, Lauren R Ammerman, Ferdinand Mugusi, Wafaie Fawzi, Richard Green, Robert Murphy. 1. *Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; †Management and Development for Health, Dar es Salaam, Tanzania; ‡Department of Medicine, Johns Hopkins University, Baltimore, MD; §Northwestern University Feinberg School of Medicine, Chicago, IL; ‖Department of Medicine, Muhumbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and ¶Departments of Nutrition, Epidemiology and Global Health and Population, Harvard T. H Chan School of Public Health, Boston, MA.
Abstract
BACKGROUND: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B virus (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 coinfection in Tanzania. METHODS: Using a cross-sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV monoinfected, HBV monoinfected, and HIV/HBV-coinfected 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: Two hundred sixty-seven HIV-infected, 165 HBV-infected, and 63 HIV/HBV-coinfected patients were analyzed [44% men, median age 37 (interquartile range 14), body mass index 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, P < 0.001, R = 0.61). Overall median APRI scores were low {HIV/HBV [0.36 (interquartile range 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (P < 0.01)}. In multivariate analyses, HIV/HBV coinfection was associated with APRI >0.5 [HIV/HBV vs. HIV: odds ratio (OR) 3.78 (95% confidence interval: 1.91 to 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26 to 5.44)]. HIV RNA per 1 log10 copies/mL increase [OR 1.53 (95% confidence interval: 1.04 to 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 coinfection 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 coinfection is warranted.
BACKGROUND: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B virus (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 coinfection in Tanzania. METHODS: Using a cross-sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV monoinfected, HBV monoinfected, and HIV/HBV-coinfected 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: Two hundred sixty-seven HIV-infected, 165 HBV-infected, and 63 HIV/HBV-coinfectedpatients were analyzed [44% men, median age 37 (interquartile range 14), body mass index 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, P < 0.001, R = 0.61). Overall median APRI scores were low {HIV/HBV [0.36 (interquartile range 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (P < 0.01)}. In multivariate analyses, HIV/HBV coinfection was associated with APRI >0.5 [HIV/HBV vs. HIV: odds ratio (OR) 3.78 (95% confidence interval: 1.91 to 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26 to 5.44)]. HIV RNA per 1 log10 copies/mL increase [OR 1.53 (95% confidence interval: 1.04 to 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-infectedpatients, respectively. CONCLUSIONS:HIV/HBV coinfection 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 coinfection is warranted.
Authors: Richard K Sterling; Eduardo Lissen; Nathan Clumeck; Ricard Sola; Mendes Cassia Correa; Julio Montaner; Mark S Sulkowski; Francesca J Torriani; Doug T Dieterich; David L Thomas; Diethelm Messinger; Mark Nelson Journal: Hepatology Date: 2006-06 Impact factor: 17.425
Authors: Michael J Vinikoor; Lloyd Mulenga; Alice Siyunda; Kalo Musukuma; Roma Chilengi; Carolyn Bolton Moore; Benjamin H Chi; Mary-Ann Davies; Matthias Egger; Gilles Wandeler Journal: Trop Med Int Health Date: 2016-08-30 Impact factor: 2.622
Authors: Lara Stabinski; Steven J Reynolds; Ponsiano Ocama; Oliver Laeyendecker; Anthony Ndyanabo; Valerian Kiggundu; Iga Boaz; Ron H Gray; Maria Wawer; Chloe Thio; David L Thomas; Thomas C Quinn; Gregory D Kirk Journal: Antivir Ther Date: 2011
Authors: Chun-Tao Wai; Joel K Greenson; Robert J Fontana; John D Kalbfleisch; Jorge A Marrero; Hari S Conjeevaram; Anna S-F Lok Journal: Hepatology Date: 2003-08 Impact factor: 17.425
Authors: Chloe L Thio; Eric C Seaberg; Richard Skolasky; John Phair; Barbara Visscher; Alvaro Muñoz; David L Thomas Journal: Lancet Date: 2002-12-14 Impact factor: 79.321
Authors: Guenter Froeschl; Michael Hoelscher; Lucas Henze Maganga; Inge Kroidl; Petra Clowes; Steffen Geis; Elmar Saathoff; Dieter Hoffmann; Ulrike Protzer; Arne Kroidl Journal: Pan Afr Med J Date: 2021-07-06