title: High Prevalence of Liver Fibrosis in Patients with Human Immunodeficiency Virus Monoinfection and Human Immunodeficiency Virus Hepatitis-B Co-infection as Assessed by Shear Wave Elastography: Study at a Teaching Hospital in Kenya.
abstract: OBJECTIVE
  The aim of this study was to determine the prevalence of liver fibrosis in patients with human immunodeficiency virus (HIV) monoinfection versus those with HIV hepatitis-B virus (HBV) co-infection as assessed with shear wave elastography (SWE) in a tertiary sub-Saharan Africa hospital.
  
  
  METHODS
  A total of 105 consecutive patients, 70 with HIV monoinfection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for the presence of liver fibrosis the cutoff of which was 5.6 kPa. Assessment of aspartate aminotransferase-to-platelet ratio index (APRI) score (a noninvasive serum biomarker of liver fibrosis) in these patients was also done.
  
  
  RESULTS
  The prevalence of liver fibrosis was significantly higher (P < 0.0001) in patients with HIV-HBV co-infection, 25.7%, compared to those with HIV monoinfection, 7.1%. APRI score was greater in patients with HIV-HBV co-infection than those with HIV monoinfection. HIV co-infection with HBV accelerates progression to liver fibrosis. Association of a low cluster of differentiation 4 (CD-4) count with advanced fibrosis supports earlier starting of antiretroviral therapy to prevent rapid progression of liver disease in HIV-positive patients.
  
  
  CONCLUSIONS
  In view of the high prevalence of liver fibrosis in patients with HIV-HBV co-infection, regular monitoring of the disease progression is recommended.
authors.affiliation: Department of Radiology and Imaging, Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Samuel Nguku
authors.initials: SN
authors.lastname: Gitau
authors.affiliation: Department of Radiology and Imaging, Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Vinayak
authors.affiliation: Department of Radiology and Imaging, Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Micah
authors.initials: M
authors.lastname: Silaba
authors.affiliation: Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Rodney
authors.initials: R
authors.lastname: Adam
authors.affiliation: Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Reena
authors.initials: R
authors.lastname: Shah
keywords: Hepatitis-B; Human immunodeficiency virus; liver fibrosis; shear wave elastography