Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared.
OBJECTIVE
To examine the association between hepatitis B virus (HBV) infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland.


METHODS
HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland were included. Liver fibrosis was evaluated using the aspartate aminotransferase-to-platelet-ratio index (APRI), with a ratio >1.5 defining significant fibrosis and a ratio >2.0 indicating cirrhosis. The association between hepatitis B surface antigen (HBsAg) positivity, HBV replication, and liver fibrosis was examined using logistic regression.


RESULTS
In Zambia, 96 (13.0%) of 739 patients were HBsAg-positive compared to 93 (4.5%) of 2058 in Switzerland. HBsAg-positive patients were more likely to have significant liver fibrosis than HBsAg-negative ones: the adjusted odds ratio (aOR) was 3.25 (95% confidence interval (CI) 1.44-7.33) in Zambia and 2.50 (95% CI 1.19-5.25) in Switzerland. Patients with a high HBV viral load (≥20000 IU/ml) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with an undetectable viral load: aOR 3.85 (95% CI 1.29-11.44) in Zambia and 4.20 (95% CI 1.64-10.76) in Switzerland. In both settings, male sex was a strong risk factor for significant liver fibrosis.


CONCLUSIONS
Despite the differences in HBV natural history between Sub-Saharan Africa and Europe, the degree of liver fibrosis and the association with important risk factors were similar.
Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. Electronic address: gilles.wandeler@ispm.unibe.ch.
Gilles
G
Wandeler
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Medicine, University of Zambia, Lusaka, Zambia.
Lloyd
L
Mulenga
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Michael J
MJ
Vinikoor
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Helen
H
Kovari
University Hospital Basel, Basel, Switzerland.
Manuel
M
Battegay
University Hospital Geneva, Geneva, Switzerland.
Alexandra
A
Calmy
University Hospital Lausanne, Lausanne, Switzerland.
Matthias
M
Cavassini
Regional Hospital, Lugano, Switzerland.
Enos
E
Bernasconi
Cantonal Hospital, St. Gallen, Switzerland.
Patrick
P
Schmid
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Carolyn
C
Bolton-Moore
Department of Medicine, University of Zambia, Lusaka, Zambia.
Edford
E
Sinkala
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
Benjamin H
BH
Chi
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
Matthias
M
Egger
Department of Infectious Diseases, Bern University Hospital and University of Bern, CH-3010 Bern, Switzerland.
Andri
A
Rauch
D000293:Adolescent; D000328:Adult; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001792:Blood Platelets / Q000378:metabolism; D015331:Cohort Studies; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006515:Hepatitis B virus / Q000235:genetics* / Q000276:immunology / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
D006514:Hepatitis B Surface Antigens; D001219:Aspartate Aminotransferases
HIV; Hepatitis B infection; Liver fibrosis; Switzerland; Zambia