title: Association between hepatitis B co-infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia.
abstract: OBJECTIVE
  To describe liver disease epidemiology among HIV-infected individuals in Zambia.
  
  
  METHODS
  We recruited HIV-infected adults (≥18 years) at antiretroviral therapy initiation at two facilities in Lusaka. Using vibration controlled transient elastography, we assessed liver stiffness, a surrogate for fibrosis/cirrhosis, and analysed liver stiffness measurements (LSM) according to established thresholds (>7.0 kPa for significant fibrosis and >11.0 kPa for cirrhosis). All participants underwent standardised screening for potential causes of liver disease including chronic hepatitis B (HBV) and C virus co-infection, herbal medicine, and alcohol use. We used multivariable logistic regression to identify factors associated with elevated liver stiffness.
  
  
  RESULTS
  Among 798 HIV-infected patients, 651 had a valid LSM (median age, 34 years; 53% female). HBV co-infection (12%) and alcohol use disorders (41%) were common and hepatitis C virus co-infection (<1%) was rare. According to LSM, 75 (12%) had significant fibrosis and 13 (2%) had cirrhosis. In multivariable analysis, HBV co-infection as well as male sex, increased age and WHO clinical stage 3 or 4 were independently associated with LSM >7.0 kPa (all P < 0.05). HBV co-infection was the only independent risk factor for LSM >11.0 kPa. Among HIV-HBV patients, those with elevated ALT and HBV viral load were more likely to have significant liver fibrosis than patients with normal markers of HBV activity.
  
  
  CONCLUSIONS
  HBV co-infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimise treatment outcomes.
authors: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. mjv3@uab.edu.|Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. mjv3@uab.edu.|Department of Medicine, University of Zambia, Lusaka, Zambia. mjv3@uab.edu.
authors: Michael J
authors: MJ
authors: Vinikoor
authors: Department of Medicine, University of Zambia, Lusaka, Zambia.|University Teaching Hospital, Lusaka, Zambia.
authors: Lloyd
authors: L
authors: Mulenga
authors: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Alice
authors: A
authors: Siyunda
authors: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Kalo
authors: K
authors: Musukuma
authors: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Roma
authors: R
authors: Chilengi
authors: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.|Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Carolyn Bolton
authors: CB
authors: Moore
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: Benjamin H
authors: BH
authors: Chi
authors: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors: Mary-Ann
authors: MA
authors: Davies
authors: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.|Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors: Matthias
authors: M
authors: Egger
authors: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Infectious Diseases, University of Dakar, Dakar, Senegal.
authors: Gilles
authors: G
authors: Wandeler
mesh_terms: D000328:Adult; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D015024:Zambia
keywords: Africa; Afrique; HIV/AIDS; VIH/SIDA; alcohol use disorder; alcoholismo; elastografía transitoria; fibrose hépatique; fibrosis hepática; hepatitis B virus; liver fibrosis; transient elastography; trouble de la consommation d'alcool; virus de l'hépatite B; virus hepatitis B; África; élastographie transitoire