Association between hepatitis B infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia


Vinikoor MJ, Mulenga L, Siyunda A, Musukuma K, Chilengi R, Moore CB, Chi BH, Davies MA, Egger M, Wandeler G.


Trop Med Int Health. 2016 Aug 6. doi: 10.1111/tmi.12764. [Epub ahead of print]


To describe the liver disease epidemiology among HIV-infected individuals in Zambia.


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 analyzed liver stiffness measurements (LSM) according to established thresholds (>7.0 kPa for significant fibrosis and >11.0 kPa for cirrhosis). All participants underwent standardized 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.


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.


HBV co-infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimize treatment outcomes. This article is protected by copyright. All rights reserved.

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