Impact of Antiretroviral Therapy on Liver Fibrosis Among Human Immunodeficiency Virus-Infected Adults With and Without HBV Coinfection in Zambia.
BACKGROUND
We investigated changes in hepatic fibrosis, based on transient elastography (TE), among human immunodeficiency virus (HIV)-infected patients with and without hepatitis B virus (HBV) coinfection on antiretroviral therapy (ART) in Zambia.


METHODS
Patients' liver stiffness measurements (LSM; kiloPascals [kPa]) at ART initiation were categorized as no or minimal fibrosis (equivalent to Metavir F0-F1), significant fibrosis (F2-F3), and cirrhosis (F4). TE was repeated following 1 year of ART. Stratified by HBV coinfection status (hepatitis B surface antigen positive at baseline), we described LSM change and the proportion with an increase/decrease in fibrosis category. Using multivariable logistic regression, we assessed correlates of significant fibrosis/cirrhosis at 1 year on ART.


RESULTS
Among 463 patients analyzed (61 with HBV coinfection), median age was 35 years, 53.7% were women, and median baseline CD4+ count was 240 cells/mm3. Nearly all (97.6%) patients received tenofovir disoproxil fumarate-containing ART, in line with nationally recommended first-line treatment. The median LSM change was -0.70 kPa (95% confidence interval, -3.0 to +1.7) and was similar with and without HBV coinfection. Significant fibrosis/cirrhosis decreased in frequency from 14.0% to 6.7% (P < .001). Increased age, male sex, and HBV coinfection predicted significant fibrosis/cirrhosis at 1 year (all P < .05).


CONCLUSIONS
The percentage of HIV-infected Zambian adults with elevated liver stiffness suggestive of significant fibrosis/cirrhosis decreased following ART initiation-regardless of HBV status. This suggests that HIV infection plays a role in liver inflammation. HBV-coinfected patients were more likely to have significant fibrosis/cirrhosis at 1 year on ART.


BACKGROUND
NCT02060162.
Department of Medicine, University of Alabama at Birmingham.|Centre for Infectious Disease Research in Zambia.|School of Medicine, University of Zambia, and.
Michael J
MJ
Vinikoor
School of Medicine, University of Zambia, and.|Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
Edford
E
Sinkala
Centre for Infectious Disease Research in Zambia.
Roma
R
Chilengi
School of Medicine, University of Zambia, and.|Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
Lloyd B
LB
Mulenga
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill.
Benjamin H
BH
Chi
Centre for Infectious Disease Research in Zambia.
Zude
Z
Zyambo
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Christopher J
CJ
Hoffmann
Department of Medicine, University of Alabama at Birmingham.
Michael S
MS
Saag
School of Public Health and Family Medicine, University of Cape Town, South Africa.
Mary-Ann
MA
Davies
Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Matthias
M
Egger
Institute of Social and Preventive Medicine, University of Bern, Switzerland.|Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Gilles
G
Wandeler
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy* / Q000821:virology; D003521:Cyclopropanes; D054459:Elasticity Imaging Techniques; D000068679:Emtricitabine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000821:virology*; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D019562:Viral Load / Q000187:drug effects; D015024:Zambia / Q000453:epidemiology
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D006514:Hepatitis B Surface Antigens; D000068679:Emtricitabine; C098320:efavirenz
Africa; HIV/AIDS; hepatitis B virus; liver fibrosis; transient elastography.