title: Prevalence and Outcomes of Hepatitis B Coinfection and Associated Liver Disease Among Antiretroviral Therapy-Naive Individuals in a Rural Tanzanian Human Immunodeficiency Virus Cohort.
abstract: Background.We evaluated the prevalence of chronic hepatitis B virus (HBV) infection and liver fibrosis/cirrhosis in human immunodeficiency virus (HIV)-infected individuals enrolled in a rural Tanzanian prospective cohort and assessed hepatic fibrosis progression 12-24 months after antiretroviral treatment (ART) initiation.Methods.All ART-naive HIV-infected adults ≥15-year-old enrolled in the Kilombero and Ulanga Antiretroviral Cohort who started ART between 2005 and 2015 were included. Pre-ART factors associated with significant liver fibrosis (aspartate aminotransferase-to-platelet ratio index [APRI] >1.5) and cirrhosis (APRI > 2.0) were identified using logistic regression.Results.Of 3097 individuals screened, 227 (7.3%; 95% CI, 6.4-8.2) were hepatitis B surface antigen (HBsAg) positive. Before ART initiation, 9.1% individuals had significant liver fibrosis and 5.3% had cirrhosis. Human immunodeficiency virus/HBV-coinfected individuals were more likely to have an APRI score indicating significant fibrosis (14.2% vs 8.7%,P= .03) and cirrhosis (9.2% vs 4.9%,P= .03) than HBV-uninfected patients. CD4 cell count <200 cell/μL and alcohol consumption were independently associated with pre-ART APRI score, indicating significant fibrosis and cirrhosis in multivariable analyses. Among individuals with elevated APRI measurements pre- and 12-24 months post-ART initiation, 53 of 57 (93.0%) of HIV-monoinfected and 4 of 5 (80.0%) of HIV/HBV-coinfected had a regression to APRI < 1.5.Conclusions.Hepatic fibrosis and cirrhosis were common in our cohort, especially among HIV/HBV-coinfected individuals. The APRI improved in most patients. Pre-ART HBsAg screening and early onset of tenofovir-based ART for HIV/HBV-coinfection should be prioritized in sub-Saharan Africa.
authors.affiliation: Department of Internal Medicine and Infectious Diseases , University Hospital Son Espases , Palma de Mallorca , Spain.
authors.forename: Adrià
authors.initials: A
authors.lastname: Ramírez-Mena
authors.affiliation: Swiss Tropical and Public Health Institute of Basel; University of Basel.
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Glass
authors.affiliation: Department of Infectious Diseases , Bern University Hospital, University of Bern , Switzerland.
authors.forename: Annja
authors.initials: A
authors.lastname: Winter
authors.affiliation: Ifakara Health Institute, Ifakara Branch , United Republic of Tanzania.
authors.forename: Namvua
authors.initials: N
authors.lastname: Kimera
authors.affiliation: Ifakara Health Institute, Ifakara Branch , United Republic of Tanzania.
authors.forename: Alex
authors.initials: A
authors.lastname: Ntamatungiro
authors.affiliation: Swiss Tropical and Public Health Institute of Basel; University of Basel.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: Swiss Tropical and Public Health Institute of Basel; University of Basel.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.affiliation: University of Basel; Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University Basel.
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.affiliation: Department of Infectious Diseases , Bern University Hospital, University of Bern , Switzerland.
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Infectious Diseases, University Hospital Dakar, Senegal.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.affiliation: Swiss Tropical and Public Health Institute of Basel; University of Basel; Ifakara Health Institute, Ifakara Branch, United Republic of Tanzania; ISGlobal, Centro de Investigación en Salud Internacional de Barcelona, Hospital Clínic-Universitat de Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Letang
keywords: APRI; HIV; Tanzania; hepatitis B virus; liver fibrosis