title: Alcohol use, viral hepatitis and liver fibrosis among HIV-positive persons in West Africa: a cross-sectional study.
abstract: Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. However, little is known about liver fibrosis and its correlates among PLWHIV in sub-Saharan Africa.
  
  
  
  The study was undertaken in three HIV referral clinics in Côte d'Ivoire, Senegal and Togo. Enrolled PLWHIV underwent a non-invasive assessment of liver fibrosis combining liver stiffness measure (LSM) with transient elastography and the aspartate aminotransferase-to-platelet ratio index (APRI). Significant liver fibrosis was defined as LSM ≥7.1 kPa. Patients were screened for alcohol use (alcohol use disorder identification test (AUDIT)-C questionnaire), hepatitis B virus (HBV) antigen, hepatitis Delta virus (HDV) antibody and anti-hepatitis C (HCV) antibody. A logistic regression model was used to identify the factors associated with significant liver fibrosis.
  
  
  
  A total of 807 PLWHIV were screened at a median age of 43 years (interquartile range (IQR): 36-50). Their median CD4 count was 393 cells/mm3(IQR: 234-563) and 682 (84.5%) were on antiretroviral therapy (ART). The prevalence of significant fibrosis was 5.3% (3.8-6.7). Infections with HBV and HCV were identified in 74 (9.2%) and nine (1.1%) participants. Main factors associated with liver fibrosis were alcohol use (AUDIT-C >6): (odds ratio (OR) = 4.0, confidence interval (CI): 1.2-14.0), (Ref. AUDIT-C <4) and HBV infection (OR = 2.9, CI: 1.2-7.2). Of the 74 patients positively screened for HBV, 50.0% were on a tenofovir-based ART regimen. Overall, 10% of HIV/HBV coinfected patients were detected with a positive HDV antibody with a higher prevalence in patients with a significant liver fibrosis (43.0%) compared to others (6.3%) (p= 0.01).
  
  
  
  Considering the WHO recommendations to screen for HBV infection and treat co-infected patients with tenofovir-based ART, screening of alcohol use and brief interventions to prevent alcohol abuse should be implemented in West Africa, especially in HBV/HIV co-infected patients.
authors.affiliation: INSERM U1219 Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Jaquet
authors.affiliation: Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.|Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.affiliation: Programme PACCI, CHU Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Marcellin
authors.initials: M
authors.lastname: Nouaman
authors.affiliation: INSERM U1219 Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.|Programme PACCI, CHU Treichville, Abidjan, Côte d'Ivoire.|Département de santé publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo.
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.
authors.forename: Judicaël
authors.initials: J
authors.lastname: Tine
authors.affiliation: Service de maladies infectieuses et tropicales, CHU Sylvanus Olympio, Lomé, Togo.
authors.forename: Akouda
authors.initials: A
authors.lastname: Patassi
authors.affiliation: INSERM U1219 Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.|Programme PACCI, CHU Treichville, Abidjan, Côte d'Ivoire.|Service de maladies infectieuses et tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.affiliation: Service de maladies infectieuses et tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Aristophane
authors.initials: A
authors.lastname: Tanon
authors.affiliation: Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.
authors.forename: Moussa
authors.initials: M
authors.lastname: Seydi
authors.affiliation: Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: Alain
authors.initials: A
authors.lastname: Attia
authors.affiliation: INSERM U1219 Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000453:epidemiology; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012675:Senegal / Q000453:epidemiology; D014037:Togo / Q000453:epidemiology
keywords: Africa; HIV; alcohol; hepatitis B; hepatitis C; hepatitis D; liver fibrosis