Wandeler G, Mulenga L, Vinikoor MJ, Kovari H, Battegay M, Calmy A, Cavassini M, Bernasconi E, Schmid P, Bolton-Moore C, Sinkala E, Chi BH, Egger M, Rauch A; for IeDEA-Southern Africa, the Swiss HIV Cohort Study.
To examine the association between HBV infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland.
DESIGN AND METHODS:
We included HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland. Liver fibrosis was evaluated using the AST-to-Platelet-Ratio Index (APRI), with a ratio >1.5 defining significant fibrosis and >2.0 cirrhosis. The association between HBsAg-positivity, HBV replication and liver fibrosis was examined using logistic regression.
In Zambia 96 (13.0%) of 739 patients were HBsAg-positive compared to 93 (4.5%) of 2,058 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% CI 1.44-7.33) in Zambia and 2.50 (1.19-5.25) in Switzerland. Patients with high HBV viral load (≥20,000 UI/mL) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with undetectable viral load: aOR 3.85 (1.29-11.44) in Zambia and 4.20 (1.64-10.76) in Switzerland. In both settings male sex was a strong risk factor for significant liver fibrosis.
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.