title: High prevalence of liver fibrosis associated with HIV infection: a study in rural Rakai, Uganda.
abstract: BACKGROUND
  Liver disease is a leading cause of mortality among HIV-infected persons in the United States and Europe. However, data regarding the effects of HIV and antiretroviral therapy (ART) on liver disease in Africa are sparse.
  
  
  METHODS
  A total of 500 HIV-infected participants in an HIV care programme in rural Rakai, Uganda were frequency-matched by age, gender and site to 500 HIV-uninfected participants in a population cohort. All participants underwent transient elastography (FibroScan(®)) to quantify liver stiffness measurements (LSM) and identify participants with significant liver fibrosis, defined as LSM≥9.3 kPa (≈ Metavir F≥2). Risk factors for liver fibrosis were identified by estimating adjusted prevalence risk ratios (adjPRR) and 95% CI using modified Poisson multivariate regression.
  
  
  RESULTS
  The prevalence of hepatitis B coinfection in the study population was 5%. The prevalence of significant fibrosis was 17% among HIV-infected and 11% in HIV-uninfected participants (P=0.008). HIV infection was associated with a 50% increase in liver fibrosis (adjPRR 1.5, 95% CI 1.1-2.1; P=0.010). Fibrosis was also associated with male gender (adjPRR 1.4, 95% CI 1.0-1.9; P=0.045), herbal medicine use (adjPRR 2.0, 95% CI 1.2-3.3; P=0.005), heavy alcohol consumption (adjPRR 2.3, 95% CI 1.3-3.9; P=0.005), occupational fishing (adjPRR 2.5, 95% CI 1.2-5.3; P=0.019) and chronic HBV infection (adjPRR 1.7, 95% CI 1.0-3.1; P=0.058). Among HIV-infected participants, ART reduced fibrosis risk (adjPRR 0.6, 95% CI 0.4-1.0; P=0.030).
  
  
  CONCLUSIONS
  The burden of liver fibrosis among HIV-infected rural Ugandans is high. These data suggest that liver disease may represent a significant cause of HIV-related morbidity and mortality in Africa.
authors.affiliation: Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. stabinskil@niaid.nih.gov
authors.forename: Lara
authors.initials: L
authors.lastname: Stabinski
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Ponsiano
authors.initials: P
authors.lastname: Ocama
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.forename: Anthony
authors.initials: A
authors.lastname: Ndyanabo
authors.forename: Valerian
authors.initials: V
authors.lastname: Kiggundu
authors.forename: Iga
authors.initials: I
authors.lastname: Boaz
authors.forename: Ron H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: Chloe
authors.initials: C
authors.lastname: Thio
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
mesh_terms: D000328:Adult; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014454:Uganda / Q000453:epidemiology